The cardiovascular safety profile of hypoxia inducible factor prolyl hydroxylase inhibitors (HIF-PHI) and erythropoiesis-stimulating agents (ESA) appear comparable in adults with dialysis-dependent and nondialysis-dependent chronic kidney disease (CKD), according to a poster presentation at the World Congress of Nephrology 2024 in Buenos Aires, Argentina.
The composite risk for MACE, including myocardial infarction, stroke, and all-cause death, did not differ significantly among 13,230 patients on dialysis taking these drugs in a meta-analysis of 13 trials and among 13,248 patients with nondialysis-dependent CKD taking these drugs in a meta-analysis of 12 trials, Sunil Badve, MD, of The George Institute for Global Health in Sydney, Australia, and colleagues reported.
In analyses of patients with nondialysis-dependent CKD, MACE risk did not differ significantly between patients receiving HIF-PHI vs placebo. Individual risks for myocardial infarction, stroke, cardiovascular death, and all-cause death also appeared comparable between HIF-PHI recipients and ESA or placebo recipients.
The investigators found that dialysis access thrombosis, venous thromboembolism, infections, and hyperkalemia occurred more frequently with HIF-PHI in placebo-controlled trials but not in ESA-controlled trials. Seizures occurred more frequently with HIF-PHI compared with ESAs or placebo.
Esophageal or gastric erosion occurred more frequently with HIF-PHI in nondialysis-dependent CKD, but less frequently in dialysis-dependent CKD.
References:
Ha J, Hiremath S, Jun M, et al. Long-term safety of hypoxia inducible factor prolyl hydroxylase inhibitors in chronic kidney disease: a systematic review and meta-analysis of randomized trials. Presented at the World Congress of Nephrology, April 13-16, Buenos Aires, Argentina. Abstract WCN24-2313.
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