Table 3.

Key recommendations of the Asian-Pacific Society of Nephrology regarding the use of hypoxia-inducible factor prolyl hydroxylase inhibitors⁸⁴

•Physicians can consider HIF-PH inhibitors as an alternative to ESA in correcting and maintaining hemoglobin level in NDD- and DD-CKD patients •Iron deficiency should be corrected (ferritin > 100 ng/dl and TSAT > 20%) before HIF stabilizers are initiated • HIF-PH inhibitors may be preferred to ESAs ○ If frequency of hospital/clinic visits or invasiveness of injections is a burden ○ If target hemoglobin cannot be achieved with ESA •Administration of HIF-PH inhibitors should be undertaken with great caution, if at all, in patients with known malignancy •Given the theoretical risk of retinopathy, prompt ophthalmologic evaluation should be ordered for patients who report visual disturbance after drug initiation •Regular monitoring of liver function should be considered given uncommon but possible risk of liver injury from HIF-PH inhibitors •Serum potassium should be monitored during treatment with HIF-PH inhibitors given reports of hyperkalemia in clinical trials •Although there are no data suggesting HIF-PH inhibitors increase blood pressure, attention should be paid to blood pressure control in patients receiving these agents •Given theoretical effects on pulmonary hypertension, attention should be paid to changes in cardiac function in patients receiving HIF-PH inhibitors •Limited use of HIF-PH inhibitors is suggested in patients with a history of thrombotic events •Cyst size should be monitored in patients with polycystic kidney disease receiving HIF-PH inhibitors

CKD, chronic kidney disease; DD, dialysis dependent; ESA, erythropoiesis-stimulating agent; HIF-PH, hypoxia-inducible factor prolyl hydroxylase; NDD, non–dialysis dependent; TSAT, transferrin saturation.