Efficacy and safety of Desidustat versus Erythropoietin in post kidney transplant anemia: a prospective observational study

BackgroundPost-renal transplant anemia significantly impacts patient outcomes and quality of life. The only option available until recently was erythropoietin (EPO) that requires intravenous or subcutaneous injection. New class of drugs that are Hypoxia-Inducible Factor Prolyl Hydroxylase Inhibitor (HIF PHI) have become available and there is scarce data on their use in kidney transplant recipients (KTRs). MethodsThis was prospective observational study which included 58 renal transplant recipients with anemia (Hb < 10 g/dL) who were started on either oral HIF PHI in the form of Desidustat (n=30) or EPO (n=28) based on nephrologist discretion. Adult KTRs with a hemoglobin (Hb) level of less than 10 gm/dl were included. Patients with acute graft dysfunction, bleeding and primary haematological diseases were excluded. Baseline clinical characteristics were recorded. Primary outcomes were change in Hb at 8 weeks in the two groups. Secondary outcomes included inflammatory markers (CRP, ESR), iron indices, and safety. Results58 patients were enrolled in the study; 30 received desidustat and 28 received erythropoietin. Both groups showed significant improvement in Hb from baseline to 2 months (Desidustat: 8.69 {+/-} 0.86 g/dL to 9.89 {+/-} 0.92 g/dL; EPO: 8.54 {+/-} 0.73 g/dL to 9.55 {+/-} 0.71 g/dL; p > 0.05). No significant differences were observed in inflammatory markers or iron indices. Both treatments were well-tolerated, with no reported adverse events. ConclusionsDesidustat demonstrated comparable efficacy and safety to EPO, with the added benefit of oral administration. It presents a promising alternative for anemia management in post-renal transplant patients.