Association of Heart Failure Hospitalization Risk with HIF-PHIs vs ESAs

Overview

This study investigates the risk of heart failure hospitalization associated with hypoxia-inducible factor prolyl hydroxylase inhibitors (HIF-PHIs) compared to erythropoiesis-stimulating agents (ESAs) in patients with chronic kidney disease. Findings indicate an association between HIF-PHI treatment and heart failure hospitalization, particularly in patients with a history of heart failure.

Background

HIF-PHIs are emerging therapies for renal anemia in chronic kidney disease (CKD) patients, but concerns regarding their cardiovascular safety have been raised. This study aims to address the evidence gap regarding heart failure hospitalization outcomes associated with these treatments.

Data Highlights

No numerical data provided in the source material.

Key Findings

• Daprodustat was associated with a 22% increased risk of first heart failure hospitalization compared to ESAs (HR 1.22; 95% CI: 0.95–1.56).
• The risk was higher in patients with a history of heart failure (HR 1.37; 95% CI: 0.89–2.11).
• For total heart failure hospitalization events, daprodustat showed a 46% increased risk (HR 1.46; 95% CI: 1.11–1.92).
• Evidence from routine practice on heart failure outcomes with HIF-PHIs remains limited.
• ASCEND trials did not enroll patients with severe heart failure or recent cardiovascular events.
• Cardiovascular safety during renal anemia therapy is a consideration for high-risk non-dialysis CKD patients.

Clinical Implications

Clinicians should consider the risk of heart failure hospitalization when prescribing HIF-PHIs, particularly in patients with a history of heart failure.

Conclusion

The findings indicate an association between HIF-PHI treatment and heart failure hospitalization risk.

Related Resources & Content

1. KDIGO, KDIGO, 2026 -- Anemia in CKD Guideline Key Takeaways for HCPs
2. Daprodustat for the Treatment of Anemia in Patients Undergoing Dialysis, New England Journal of Medicine, 2021 -- Daprodustat for the Treatment of Anemia in Patients Undergoing Dialysis
3. Safety and Efficacy of Vadadustat for Anemia in Patients Undergoing Dialysis, New England Journal of Medicine, 2020 -- Safety and Efficacy of Vadadustat for Anemia in Patients Undergoing Dialysis
4. Drugs - Real World Outcomes — Investigating the Link Between Heart Rate Management and Readmission Rates: A Real-World Study of Patients with Heart Failure and Reduced Ejection Fraction
5. Clinical Research in Cardiology — Impact of Heart Failure Stage and Left Ventricular Ejection Fraction on Prognosis in Patients Experiencing In-Hospital Cardiac Arrest: Findings from a 16-Year Retrospective Cohort Analysis
6. Clinical Research in Cardiology — Analysis of Heart Failure Prevalence in Germany: A Retrospective Review of Database Records
7. Frontiers in Cardiovascular Medicine — E/e' Ratio Combined with Left Ventricular Mass Index Predicts HFpEF Rehospitalization Risk in Stage 3-4 Chronic Kidney Disease Patients: A Retrospective Cohort Study
8. Anemia Key Takeaways Healthcare Pros copy
9. Daprodustat for the Treatment of Anemia in Patients Undergoing Dialysis | New England Journal of Medicine
10. Safety and Efficacy of Vadadustat for Anemia in Patients Undergoing Dialysis | New England Journal of Medicine