Conclusions & Disclosure
Current data suggests that HIF-PHIs are non-inferior to conventional ESA in maintaining haemoglobin concentration in both non-dialysis and dialysis dependent CKD. The cardiovascular safety of HIF-PHI over conventional ESA has not definitively been established, and the class may be associated with increased risk of thrombosis. Patients with active or recent malignancy, and those living with polycy
Current data suggests that HIF-PHIs are non-inferior to conventional ESA in maintaining haemoglobin concentration in both non-dialysis and dialysis dependent CKD. The cardiovascular safety of HIF-PHI over conventional ESA has not definitively been established, and the class may be associated with increased risk of thrombosis. Patients with active or recent malignancy, and those living with polycystic kidney diseases, should probably not be prescribed HIF-PHI until the effect of this class on these disease categories is better established; patients with retinopathy are an additional group of concern. Patients refractory to conventional ESA due to chronic inflammation may constitute a group in whom prescription of HIF-PHI may facilitate haemoglobin correction, should overt contraindication be excluded. Prescription of the HIF-PHI should however not substitute thorough 101 investigation for the aetiology of ESA resistance nor appropriate management thereof. Lack of overt benefit of the HIF-PHI should not preclude prescription in preference to conventional ESA in consideration of possible advantages for individual patients such as ease of administration.
Disclosure
This consensus statement aims to provide information and assist decision making. It is not intended to define a standard of care, nor dictate an absolute course of management. Health-care professionals utilising this consensus statement are responsible for evaluating the appropriateness of the application to any clinical situation, by taking into account the individual needs and preferences of each patient, available resources, and institution/ practice limitations.
South African Nephrology Society (SANS). Consensus Statement on the Use of Hypoxia-Inducible Factor-Prolyl Hydroxylase Inhibitors (HIF-PHIs). South African Nephrology Society; 2023.