| Consider use of HIF-PHi |
| NDD-CKD or PD patients • Patient preference for oral treatment (accessibility, convenience, ease of administration, no storage requirements) • Challenges to starting or receiving ESAs (needle-phobia, unable to self-administer ESAs) • Challenges to administering iron therapy or when increased iron availability is desired • ESA hyporesponsiveness or intolerance • Chronic inflammatory states (CRP ≥3 mg/l) |
| HD patients • Patient preference for oral treatment • Home HD • Hypersensitivity or unavailability of IV iron • ESA hyporesponsiveness or intolerance • Chronic inflammatory states (CRP ≥3 mg/l) |
| Use with caution |
| • Vascular access with a high risk of thrombotic complication • Retinal disordersa • Autoimmune diseasesb • History of cured malignancy or without recurrence for at least 5 years • Kidney transplant recipientsc |
| Avoid or use with extreme caution |
| • Patient with a cardiovascular or thrombotic event in the previous 3 months • History of malignancy in the last 5 years • Polycystic kidney disease • Untreated proliferative diabetic retinopathy, macular degeneration and retinal vein occlusion • Idiopathic pulmonary arterial hypertension |
| Administration key points |
| • Ensure adequate iron stores prior to initiating treatment (ferritin >100 µg/l, TSAT >20%)d • Individualize dose to achieve and maintain target haemoglobin levels of 10–12 g/dl |
| Monitoring key points |
| • Avoid rapid rises in haemoglobin, e.g. >2 g/dl over 4 weeks, or very high haemoglobin levels (>12 g/dl)e; in the case of haemoglobin overcorrection, consider treatment discontinuation for haemoglobin levels >13 g/dl and dose decreases for haemoglobin levels of 12–13 g/dl • Monitor haemoglobin levels at least monthly until the target haemoglobin level of 10–12 g/dl is achieved and stabilized, thereafter as clinically indicated • Monitor potassium and liver function testsf |
| Consider use of HIF-PHi |
| NDD-CKD or PD patients • Patient preference for oral treatment (accessibility, convenience, ease of administration, no storage requirements) • Challenges to starting or receiving ESAs (needle-phobia, unable to self-administer ESAs) • Challenges to administering iron therapy or when increased iron availability is desired • ESA hyporesponsiveness or intolerance • Chronic inflammatory states (CRP ≥3 mg/l) |
| HD patients • Patient preference for oral treatment • Home HD • Hypersensitivity or unavailability of IV iron • ESA hyporesponsiveness or intolerance • Chronic inflammatory states (CRP ≥3 mg/l) |
| Use with caution |
| • Vascular access with a high risk of thrombotic complication • Retinal disordersa • Autoimmune diseasesb • History of cured malignancy or without recurrence for at least 5 years • Kidney transplant recipientsc |
| Avoid or use with extreme caution |
| • Patient with a cardiovascular or thrombotic event in the previous 3 months • History of malignancy in the last 5 years • Polycystic kidney disease • Untreated proliferative diabetic retinopathy, macular degeneration and retinal vein occlusion • Idiopathic pulmonary arterial hypertension |
| Administration key points |
| • Ensure adequate iron stores prior to initiating treatment (ferritin >100 µg/l, TSAT >20%)d • Individualize dose to achieve and maintain target haemoglobin levels of 10–12 g/dl |
| Monitoring key points |
| • Avoid rapid rises in haemoglobin, e.g. >2 g/dl over 4 weeks, or very high haemoglobin levels (>12 g/dl)e; in the case of haemoglobin overcorrection, consider treatment discontinuation for haemoglobin levels >13 g/dl and dose decreases for haemoglobin levels of 12–13 g/dl • Monitor haemoglobin levels at least monthly until the target haemoglobin level of 10–12 g/dl is achieved and stabilized, thereafter as clinically indicated • Monitor potassium and liver function testsf |
Consider close ophthalmology follow-up.
Patients with a known chronic inflammatory disease that could impact erythropoiesis (e.g. systemic lupus erythematosus, rheumatoid arthritis, celiac disease), even if it was in remission were excluded in some of the trials.
Not enrolled in clinical trials, no information on potential interaction with immunosuppressive drugs, unknown effects on the immune system.
For HD patients, the PIVOTAL regime if ferritin <700 µg/l and TSAT ≤40% can be used (at least in patients with a relatively short dialysis duration and no signs of severe inflammation).
These can be associated with an increased risk of thrombotic complications.
Reports of hyperkalaemia and liver injury (uncommon) in clinical trials.
| Consider use of HIF-PHi |
| NDD-CKD or PD patients • Patient preference for oral treatment (accessibility, convenience, ease of administration, no storage requirements) • Challenges to starting or receiving ESAs (needle-phobia, unable to self-administer ESAs) • Challenges to administering iron therapy or when increased iron availability is desired • ESA hyporesponsiveness or intolerance • Chronic inflammatory states (CRP ≥3 mg/l) |
| HD patients • Patient preference for oral treatment • Home HD • Hypersensitivity or unavailability of IV iron • ESA hyporesponsiveness or intolerance • Chronic inflammatory states (CRP ≥3 mg/l) |
| Use with caution |
| • Vascular access with a high risk of thrombotic complication • Retinal disordersa • Autoimmune diseasesb • History of cured malignancy or without recurrence for at least 5 years • Kidney transplant recipientsc |
| Avoid or use with extreme caution |
| • Patient with a cardiovascular or thrombotic event in the previous 3 months • History of malignancy in the last 5 years • Polycystic kidney disease • Untreated proliferative diabetic retinopathy, macular degeneration and retinal vein occlusion • Idiopathic pulmonary arterial hypertension |
| Administration key points |
| • Ensure adequate iron stores prior to initiating treatment (ferritin >100 µg/l, TSAT >20%)d • Individualize dose to achieve and maintain target haemoglobin levels of 10–12 g/dl |
| Monitoring key points |
| • Avoid rapid rises in haemoglobin, e.g. >2 g/dl over 4 weeks, or very high haemoglobin levels (>12 g/dl)e; in the case of haemoglobin overcorrection, consider treatment discontinuation for haemoglobin levels >13 g/dl and dose decreases for haemoglobin levels of 12–13 g/dl • Monitor haemoglobin levels at least monthly until the target haemoglobin level of 10–12 g/dl is achieved and stabilized, thereafter as clinically indicated • Monitor potassium and liver function testsf |
| Consider use of HIF-PHi |
| NDD-CKD or PD patients • Patient preference for oral treatment (accessibility, convenience, ease of administration, no storage requirements) • Challenges to starting or receiving ESAs (needle-phobia, unable to self-administer ESAs) • Challenges to administering iron therapy or when increased iron availability is desired • ESA hyporesponsiveness or intolerance • Chronic inflammatory states (CRP ≥3 mg/l) |
| HD patients • Patient preference for oral treatment • Home HD • Hypersensitivity or unavailability of IV iron • ESA hyporesponsiveness or intolerance • Chronic inflammatory states (CRP ≥3 mg/l) |
| Use with caution |
| • Vascular access with a high risk of thrombotic complication • Retinal disordersa • Autoimmune diseasesb • History of cured malignancy or without recurrence for at least 5 years • Kidney transplant recipientsc |
| Avoid or use with extreme caution |
| • Patient with a cardiovascular or thrombotic event in the previous 3 months • History of malignancy in the last 5 years • Polycystic kidney disease • Untreated proliferative diabetic retinopathy, macular degeneration and retinal vein occlusion • Idiopathic pulmonary arterial hypertension |
| Administration key points |
| • Ensure adequate iron stores prior to initiating treatment (ferritin >100 µg/l, TSAT >20%)d • Individualize dose to achieve and maintain target haemoglobin levels of 10–12 g/dl |
| Monitoring key points |
| • Avoid rapid rises in haemoglobin, e.g. >2 g/dl over 4 weeks, or very high haemoglobin levels (>12 g/dl)e; in the case of haemoglobin overcorrection, consider treatment discontinuation for haemoglobin levels >13 g/dl and dose decreases for haemoglobin levels of 12–13 g/dl • Monitor haemoglobin levels at least monthly until the target haemoglobin level of 10–12 g/dl is achieved and stabilized, thereafter as clinically indicated • Monitor potassium and liver function testsf |
Consider close ophthalmology follow-up.
Patients with a known chronic inflammatory disease that could impact erythropoiesis (e.g. systemic lupus erythematosus, rheumatoid arthritis, celiac disease), even if it was in remission were excluded in some of the trials.
Not enrolled in clinical trials, no information on potential interaction with immunosuppressive drugs, unknown effects on the immune system.
For HD patients, the PIVOTAL regime if ferritin <700 µg/l and TSAT ≤40% can be used (at least in patients with a relatively short dialysis duration and no signs of severe inflammation).
These can be associated with an increased risk of thrombotic complications.
Reports of hyperkalaemia and liver injury (uncommon) in clinical trials.
This PDF is available to Subscribers Only
View Article Abstract & Purchase OptionsFor full access to this pdf, sign in to an existing account, or purchase an annual subscription.
