Consensus commentary and position of the Italian Society of Nephrology on KDIGO controversies conference on novel anemia therapies in chronic kidney disease
Hypoxia-inducible factor prolyl hydroxylase inhibitors (HIF-PHIs) are a new class of drugs designed to treat anemia associated with chronic kidney disease (CKD). These drugs promote the body’s natural production of erythropoietin and enhance both iron absorption and the mobilization of stored iron (though this is less JTZ-951 pronounced with daprodustat, vadadustat, and enarodustat). Over recent years, multiple studies have shown that HIF-PHIs are just as effective as standard therapies in treating CKD-related anemia, with a similar safety profile to erythropoiesis-stimulating agents (ESAs). However, the duration of these studies has been too short to rule out potential long-term adverse effects, such as cancer, death, or cardiovascular events, which may surface over extended follow-up periods. In 2021, the Kidney Disease: Improving Global Outcomes (KDIGO) organization held a Controversies Conference to discuss HIF-PHIs. This position paper, endorsed by the Italian Society of Nephrology, aims to align the KDIGO Conference’s conclusions with the Italian context by assessing the efficacy, safety, and use of HIF-PHIs, particularly in subpopulations highlighted in recent studies not covered during the KDIGO Conference.