Table 19:

Recommendation for desidustat as an alternatives to ESA for anemia in DD-CKD patients

Consensus Statement	This is a consensus statement, which implies that there is not enough evidence to give an evidence-informed recommendation, but the panel still regarded it as important to provide a statement to support practice decisions
The panel consensus was that desidustat might be offered an alternative to ESAs in DD patients with CKD who do not prefer ESAs. When offering desidustat, it should be thoroughly explained to the patients about the potential benefits and harms, including the very low certainty of evidence on its effectiveness and safety. Patients should be iron replete before the initiation of therapy.
Recommendation for future research	This recommendation is evidence informed.
The panel recommends conducting large multicentric trials in the South Asian region on DD-CKD patients and measuring critically important outcomes (as elucidated in this guideline) such that evidence base for desidustat is improved. Considering feasibility, acceptability, and equity considerations, and that the drug is already licensed in India, non-industry research funders should prioritize such trials. (This recommendation is evidence-informed.) Robust Phase IV studies in approved markets are also required to establish long-term safety and risk-benefit ratio. Cost-benefit analysis should be done to understand the relative cost of desidustat with ESAs.

DD: Dialysis-Dependent, CKD: Chronic kidney disease, ESA: Eythropoiesis-stimulating agents, CKD: Chronic kidney disease