ホシノ　ジュンイチ   Hoshino Junichi   星野　純一    所属   医学部 医学科（東京女子医科大学病院）    職種   教授・基幹分野長
言語種別	英語
発表タイトル	Effectiveness of Switching from Erythropoiesis-Stimulating Agents to Hypoxia-Inducible Factor-Prolyl Hydroxylase Inhibitors in Nondialysis-Dependent Patients with CKD: Reach-J CKD Cohort Study
会議名	Kidney Week 2025
主催者	American Society of Nephrology
学会区分	国際学会及び海外の学会
発表形式	ポスター掲示
講演区分	一般
発表者・共同発表者	◎Yamagata Kunihiro, Ohigashi Tomohiro, Saito Chie, Kai Hirayasu, Tsunoda Ryoya, Okubo Reiko, Kondo Masahide, Ishii Haruka, Inuzuka Masami, Harada Kenji, Narita Ichiei, Okada Hirokazu, Wada Takashi, Maruyama Shoichi, Hoshino Junichi
発表年月日	2025/11/08
国名	アメリカ合衆国
開催地 （都市, 国名）	Houston, USA
開催期間	2025/11/05～2025/11/09
概要	Background Anemia of chronic kidney disease (CKD) can be treated with erythropoiesis-stimulating agents (ESAs); however, ESA resistance can occur. Another option is hypoxia-inducible factor prolyl hydroxylase inhibitors (HIF-PHIs), which have been commercially available in Japan since 2019, but their conditions and effects in clinical settings are largely unknown. We investigated the characteristics of CKD patients switched from ESA to HIF-PHI therapy and examined treatment effects following switching to HIF–PHIs. We also examined whether HIF-PHI can maintain hemoglobin (Hb) levels, which often transiently decline with ESA therapy before and after the start of dialysis. Methods Reach-J CKD was an observational, prospective cohort study of patients with CKD (stages G3b–G5) in Japan; those who had received ESA therapy were eligible for the present analysis. Background characteristics of patients who were switched from ESA to HIF-PHI therapy were compared with those of patients who continued ESA therapy. Pre- and post-switch Hb levels and iron-related markers were compared. Continuous variables were compared using Welch’s t-test and a Mann–Whitney U test, and categorical variables using Fisher’s exact test. Results Patients switched from ESA to HIF-PHI therapy (n = 34) had significantly higher erythropoietin resistance index (ERI), and lower Hb, Fe, TSAT, serum albumin, than patients who continued ESA therapy (n = 447) (p < 0.05). Three months post switch, Hb (n = 25) and TIBC (n = 11) had increased, and changes in Hb distribution were observed. In patients switched to HIF-PHI therapy, Hb was increased in both high- and low-ERI groups. In two patients switched to HIF-PHI therapy before dialysis, there was no decrease in Hb before and after dialysis. Conclusion Patients switched from ESA to HIF-PHI therapy had high ERI and low Hb levels at baseline, and their Hb levels were increased post switch, regardless of baseline ERI. The finding that switching from ESA to HIF-PHI therapy may help maintain Hb levels before and after dialysis warrants further investigation.