Cardiorenal Division, Hospital Ana Nery, Salvador, Brazil.
Medicine and Health Program, Federal University of Bahia, Salvador, Brazil.
Blood Purif. 2023;52(7-8):721-728. doi: 10.1159/000531274. Epub 2023 Jul 17.
Anemia is a common finding among patients with advanced chronic kidney disease, especially those on dialysis. The recent introduction of hypoxia-inducible factor prolyl hydroxylase inhibitors (HIF-PHIs) has raised some concerns about the cardiovascular and thrombotic complications of this class of drugs.
This meta-analysis aimed to assess the safety of HIF-PHIs in patients with end-stage kidney disease (ESKD) versus standard therapy with erythropoiesis-stimulating agents (ESAs).
Databases were searched on April 2022. Studies that reported incidence of all-cause mortality; major cardiovascular adverse events (MACEs); myocardial infarction (MI); stroke and thrombotic events in the use of HIF-PHIs or ESA on ESKD patients in hemodialysis or peritoneal dialysis were evaluated. Data were extracted from published reports, and quality assessment was performed per Cochrane recommendations.
12,821 patients from ten randomized controlled trials were included in this study. Most patients (83%) were on hemodialysis. 6,461 (50.3%) were using HIF-PHIs, and 6,360 (49.6%) were in the ESA group. The pooled estimated incidence of all-cause mortality was 769 in the HIF-PHIs group (relative-risk ratios (RR): 1.04; confidence interval (CI): 0.95-1.14; p = 0.52; I2 = 0%). There was no difference in the groups regarding the outcomes of MACE in the analysis of the three studies that reported this outcome (RR: 0.95; CI: 0.87-1.04; p = 0.69; I2 = 0%). In addition, there was no statistical difference among the outcomes of MI, stroke, or thrombotic events.
Among patients with ESKD on dialysis, the use of HIF-PHIs was non-inferior regarding the safety outcomes when compared to standard of care therapy.
贫血是晚期慢性肾脏病患者，尤其是透析患者的常见病症。最近引入缺氧诱导因子脯氨酰羟化酶抑制剂（HIF-PHIs）引起了人们对这类药物心血管和血栓并发症的一些担忧。
本荟萃分析旨在评估 HIF-PHI 与红细胞生成刺激剂（ESA）标准治疗相比在终末期肾病（ESKD）患者中的安全性。
于 2022 年 4 月检索数据库。评估了在血液透析或腹膜透析中使用 HIF-PHI 或 ESA 的 ESKD 患者的全因死亡率；主要心血管不良事件（MACE）；心肌梗死（MI）；卒中和血栓事件发生率的研究报告。从已发表的报告中提取数据，并按照 Cochrane 建议进行质量评估。
本研究纳入了来自 10 项随机对照试验的 12821 名患者。大多数患者（83%）接受血液透析。6461 名（50.3%）患者使用 HIF-PHI，6360 名（49.6%）患者使用 ESA。HIF-PHI 组全因死亡率的估计发生率为 769 例（相对风险比（RR）：1.04；置信区间（CI）：0.95-1.14；p=0.52；I2=0%）。在分析报告这一结果的三项研究中，HIF-PHI 组与 ESA 组在 MACE 结局方面没有差异（RR：0.95；CI：0.87-1.04；p=0.69；I2=0%）。此外，MI、卒中和血栓事件的结局也没有统计学差异。
在接受透析治疗的 ESKD 患者中，与标准治疗相比，使用 HIF-PHI 在安全性结局方面没有劣势。
