Guideline 4.1 – Treatment of Anaemia – HIF-PHI Agents
We recommend that treatment with HIF-PHI agents should be offered after iron repletion, to people with symptomatic anaemia (Hb <105 g/L) of CKD (stages 3-5 (eGFR <60 ml/min/1.73m2)) who are not receiving dialysis at the start of therapy and who are likely to benefit in terms of quality of life and physical function and to avoid blood transfusion; especially in people considered suitable for transplantation. (1B)
Guideline 4.1.1 – Treatment of Anaemia – DD-CKD and HIF-PHI Agents
We suggest that that treatment with HIF-PHI agents should be considered after iron repletion, to people with DD-CKD and symptomatic anaemia (Hb <105 g/L) who are likely to benefit in terms of quality of life and physical function and to avoid blood transfusion; especially in people considered suitable for transplantation. (2B)
Guideline 4.1.2 – Treatment of Anaemia – People intolerant to ESA
We suggest that that treatment with HIF-PHI agents should be considered, after iron repletion, to people who are intolerant to ESA therapy. (2C)
Guideline 4.1.3 – Choosing between ESA and HIF-PHI therapy for people with non-dialysis dependent CKD and DD-CKD
We suggest, when deciding between ESA and HIF-PHI therapy for people with non-dialysis dependent CKD or DD-CKD, considerations include the preference of the person with anaemia of CKD, or, where appropriate, their family or carers, the cost of local drug supply, nursing and administration costs and previous treatment with ESA or HIF-PHI. (2B)
Guideline 4.2 – Treatment of Anaemia
We suggest that HIF-PHI administration in HIF-PHI-dependent people should continue during acute illness, surgical procedures or any other cause of hospitalisation, unless there is a clear contra-indication such as accelerated hypertension or thrombosis. (2C)
Guideline 4.3 – Treatment of Anaemia with HIF- PHI therapy – Target Haemoglobin:
We suggest that people over the age of 18 years with NDD-CKD on HIF-PHI therapy should achieve a Hb between:
- 100 and 120 g/L in adults and young people, similar to ESA therapy (2B)
- In children and those younger than 2 years of age no data is currently available (not graded)
Guideline 4.3.1
We suggest that people over the age of 18 years with DD-CKD on HIF-PHI therapy should achieve a Hb between:
- 100 and 120 g/L in adults and young people similar to ESA therapy but this may depend on the choice of HIF-PHI where a Hb of 100-110 g/|L is recommended. (2B)
- In children and those younger than 2 years of age no data is currently available
Guideline 4.4 – Treatment of Anaemia – Initial HIF-PHI dose
We recommend that the initial HIF-PHI dose should be based on the person’s weight, Hb level and the observed rate of increase in Hb level, and clinical circumstances. The appropriate dose should follow label recommendations until further data is available. (1B)
Guideline 4.4.1
We suggest that the starting HIF PHI dose should be lower for those who are ESA-naïve versus those who are not. (2B)
Guideline 4.5 – Treatment of Anaemia with HIF-PHI therapy – Frequency of Administration:
We suggest that the frequency of administration should be determined by the response to therapy to maintain the desired Hb target range of 100-120 g/L. (2B)
Guideline 4.6 – Treatment of Anaemia with HIF-PHI Therapy – Dose Adjustments:
We suggest that adjustments to HIF-PHI doses should be considered when Hb is <105 or >115 g/L in adults to balance the benefit and safety to people given the current evidence base. (2B)
Guideline 4.7 – Prescribing HIF-PHI in Sub-Groups of People with CKD:
We recommend that HIF-PHI should be avoided or used cautiously in people with active malignancy. (1B)
Guideline 4.7.1
We recommend that HIF-PHI should be avoided or used cautiously in people with autosomal dominant polycystic kidney disease until further data are available. (1D)
Guideline 4.7.2
We recommend that HIF-PHI should be avoided or used cautiously in people with a history of seizures. (1B)
Guideline 4.7.3
We recommend caution in using HIF-PHI in people with uncontrolled hypertension. (1B)
Guideline 4.7.4
We recommend caution in using HIF-PHI therapy in people with retinopathy. (1D)
Guideline 4.7.5
We recommend caution in people with a history of thrombotic events following the SmPC for contra-indications. (1A)
Guideline 4.7.6
We suggest that HIF-PHI may be considered in people with hyporesponsiveness to ESA therapy or underlying inflammation, but further high-quality randomised trials are needed to confirm its effectiveness. (2C)
Guideline 4.8 – Safety of HIF-PHI:
We suggest the cautious use of HIF-PHI in people with CKD and either known CVD or thrombotic events and consideration of lower dose regimes to reduce rapid rises in Hb. (2C)
Guideline 4.9 – Monitoring Response to HIF-PHI:
We recommend that Hb levels should be monitored every two weeks until the desired Hb target range of 100 to 120 g/L is achieved and stabilised, and every 4 weeks thereafter, or as clinically indicated. (1B)