Introduction
Anaemia is one of the most common complications of chronic kidney disease (CKD), affecting quality of life, exercise tolerance, cardiovascular health, and overall survival. Traditionally, the management of CKD-associated anaemia has relied on iron supplementation, erythropoiesis-stimulating agents (ESAs), and blood transfusions. The emergence of hypoxia-inducible factor prolyl hydroxylase inhibitors (HIF-PHIs) has transformed the treatment landscape. Desidustat is India’s first indigenous HIF-PHI approved for the treatment of anaemia associated with CKD.
Pathogenesis of Anaemia in CKD
Major contributors include reduced erythropoietin production, functional iron deficiency due to elevated hepcidin, chronic inflammation, uremic toxins, nutritional deficiencies, and shortened red cell survival.
Mechanism of Action
Desidustat inhibits prolyl hydroxylase domain enzymes, stabilizing HIF-alpha. This increases endogenous erythropoietin production, enhances erythropoiesis, reduces hepcidin levels, improves iron absorption and mobilization, and ultimately raises haemoglobin levels.
Approved Indications
- Anaemia due to chronic kidney disease
- Non-dialysis CKD patients
- Hemodialysis patients
- Peritoneal dialysis patients
Clinical Evidence
The DREAM clinical trial program demonstrated efficacy comparable to conventional ESAs in both dialysis-dependent and non-dialysis CKD patients, with effective haemoglobin correction and maintenance.
Advantages
- Oral administration
- Physiological endogenous erythropoietin production
- Improved iron utilization
- Potential benefit in ESA hyporesponsive patients
- Reduced dependence on injectable therapies
Applications in Clinical Practice
Desidustat is useful in non-dialysis CKD patients, hemodialysis patients, peritoneal dialysis patients, and in resource-limited settings where injectable ESA therapy may be difficult to administer.
Deciduastat needs caution for use in those with advanced proliferative diabetic retinopathy and thrombogenic events.
It’s best to consult your nephrologist for the correct usage and indication.
Monitoring
Monitor haemoglobin, ferritin, transferrin saturation, blood pressure, and clinical response. Iron deficiency should be corrected before and during therapy.
Adverse Effects
Reported adverse effects include headache, nausea, hypertension, hyperkalemia, and vascular access thrombosis.
Conclusion
Desidustat represents an important advance in CKD anaemia management. By simultaneously stimulating endogenous erythropoietin production and improving iron metabolism, it offers an effective oral alternative to traditional erythropoiesis-stimulating agents.
Dr. Balaji Kirushnan
Senior Consultant Nephrologist & Clinical Lead Nuclear Medicine, PET CT & Theranostics
Kauvery Hospital, Chennai
