Association of Hypoxia-Inducible Factor Prolyl Hydroxylase Inhibitors with Cardiovascular Events and Death in Dialysis Patients: A Systematic Review and Meta-Analysis.

Autor: Guimarães MGM; Cardiorenal Division, Hospital Ana Nery, Salvador, Brazil., Tapioca FPM; Cardiorenal Division, Hospital Ana Nery, Salvador, Brazil.; Medicine and Health Program, Federal University of Bahia, Salvador, Brazil.; Bahiana School of Medicine and Public Health, Salvador, Brazil., Neves FC; Cardiorenal Division, Hospital Ana Nery, Salvador, Brazil.; Bahiana School of Medicine and Public Health, Salvador, Brazil., Moura-Neto JA; Bahiana School of Medicine and Public Health, Salvador, Brazil., Passos LCS; Cardiorenal Division, Hospital Ana Nery, Salvador, Brazil.; Medicine and Health Program, Federal University of Bahia, Salvador, Brazil.
Jazyk: angličtina
Zdroj: Blood purification [Blood Purif] 2023; Vol. 52 (7-8), pp. 721-728. Date of Electronic Publication: 2023 Jul 17.
DOI: 10.1159/000531274
Abstrakt: Background: 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.
Objectives: 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).
Methods: 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.
Results: 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.
Conclusions: 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.
(© 2023 S. Karger AG, Basel.)
Databáze: MEDLINE
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