Balancing Efficacy, Health Status, and Cost-Effectiveness: A Comparative Study of Desidustat and Erythropoietin in Chronic Kidney Disease Patients on Hemodialysis.

Abstract

Background. Anemia is a common problem that greatly affects the quality of life and prognosis of those with CKD (chronic kidney disease). The conventional course of treatment has traditionally used ESAs (erythropoiesis-stimulating agents) such as erythropoietin; however, more recent medications, such as Desidustat, a hypoxia-inducible factor prolyl hydroxylase inhibitor (HIF-PHI), may be more advantageous in terms of both efficacy and cost. In this study, CKD patients receiving hemodialysis are compared for efficacy, safety, and cost-effectiveness between Desidustat and erythropoietin treatment. Methods. This prospective, single-center, open-label study with parallel groups was carried out at Saveetha Institute of Medical Sciences in Chennai. A total of 60 patients with CKD on maintenance hemodialysis were randomized to receive either Desidustat (100 mg orally, 3 times a week) or Erythropoietin (subcutaneous injections) for 12 weeks. At baseline, four weeks, eight weeks, and 12 weeks, hemoglobin levels, biomarkers (TSAT, ferritin, and hepcidin), and status of physical and mental health had been noted. The key finding was the proportion of hemoglobin responders (defined as a rise from baseline of ≥1g/dL). Secondary outcomes included predictors of hemoglobin response, adverse effects, and cost-effectiveness. Results. The proportion of hemoglobin responders was 83.33% in the Desidustat compared to 73.33% in the Erythropoietin group (p = 0.530), indicating no significant difference in efficacy. Hemoglobin levels increased gradually in both groups over 12 weeks. Higher serum albumin (OR = 3.32, 95% CI: 1.54-7.16, p = 0.008) and lower iPTH levels (OR = 0.98, 95% CI: 0.97-0.99, p = 0.004) have been important indicators of hemoglobin response. Hepcidin levels decreased significantly in the Desidustat group in contrast to Erythropoietin (p = 0.038), suggesting improved iron metabolism with Desidustat. No significant differences were noted in TSAT or ferritin levels. Adverse effects were comparable between the groups, with similar hospitalization and infection rates. Desidustat demonstrated better cost-effectiveness, with a lower monthly cost compared to Erythropoietin. Conclusions. When treating anemia in individuals with CKD receiving hemodialysis, Desidustat is a safe and efficient substitute for erythropoietin, with the added advantage of cost-effectiveness. Serum albumin and iPTH were significant predictors of hemoglobin response. To validate these results larger multicentric studies are necessary.