Clinical perspectives on the treatment of renal anemia with HIF stabilizers

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  • 腎性貧血治療におけるHIF stabilizerの臨床的展望
  • ジンセイ ヒンケツ チリョウ ニ オケル HIF stabilizer ノ リンショウテキ テンボウ

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Abstract

<p>Hypoxia-inducible factor (HIF) stabilizers, which are novel agents, stimulate endogenous erythropoietin by inhibiting HIF and the prolyl hydroxylase domain to mimic hypoxia. Phase 2 and 3 clinical studies have shown that HIF stabilizers are as effective as erythrocyte-stimulating agents (ESA) at ameliorating renal anemia. Long-term clinical experience has demonstrated that ESA improve patients’ quality of life and ameliorate cardiovascular-renal-anemia (CRA) syndrome, and malnutrition-inflammation-atherosclerosis (MIA) syndrome complicated by abnormal iron metabolism. Whether the same holds true in patients given HIF stabilizers is still unclear. In addition, given that HIF stabilizers act on multiple target genes, their use might result in unknown adverse events. The introduction of HIF stabilizers as a treatment for renal anemia provokes concern about how this alternative treatment will be employed in daily clinical practice. However, no clinical guidelines on how HIF stabilizers should be used are available at present due to the lack of clinical information. Nevertheless, this opinion-based review provides a future perspective on the management of renal anemia with HIF stabilizers. These novel agents could be indicated for CRA syndrome at the pre-dialysis stage; ESA-resistant anemia; and perhaps abnormal iron metabolism, such as that seen in MIA syndrome, in dialysis patients.</p>

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