Patient Considerations in the Prescription of HIF-PHIs
Patients hyporesponsive to conventional ESA due to chronic inflammation or iron deficiency may benefit from HIF-PHIs due to resultant decrease in hepcidin with improvement in iron absorption and mobilization from stores. Since efficacy trials have not specifically included patients with significantly increased C-reactive protein, this potential role for HIF-PHIs is not currently supported by subs
Patients hyporesponsive to conventional ESA due to chronic inflammation or iron deficiency may benefit from HIF-PHIs due to resultant decrease in hepcidin with improvement in iron absorption and mobilization from stores. Since efficacy trials have not specifically included patients with significantly increased C-reactive protein, this potential role for HIF-PHIs is not currently supported by substantial evidence. Prescription of HIF-PHI should not be used to circumvent workup of chronic inflammation or evaluation of ESA resistance.
Children may represent a special patient group in which an oral formulation of ESA may be particularly desirable. Lack of specific data in this regard means that this potential indication remains theoretical at this time.
In view of potential adverse effects, HIF-PHI are probably best avoided in patients with recent or active malignancy, and patients with CKD due to polycystic kidney disease.
Placental HIF-1α expression is increased in the setting of preeclampsia,22 and increased spontaneous abortion has been reported in murine preclinical drug trials. HIF-PHI metabolites have been detected in breastmilk in animal subjects. The HIF-PHIs are therefore currently contraindicated in pregnancy and in breastfeeding.
South African Nephrology Society (SANS). Consensus Statement on the Use of Hypoxia-Inducible Factor-Prolyl Hydroxylase Inhibitors (HIF-PHIs). South African Nephrology Society; 2023.