Eficácia dos inibidores de prolil-hidroxilase do fator induzível por hipóxia em comparação aos agentes estimuladores de eritropoiese para o tratamento de anemia em pacientes com doença renal crônica: revisão integrativa

Abstract

Chronic Kidney Disease (CKD) is a progressive and irreversible condition that compromises the renal system, leading to a gradual loss of kidney function. Among the most common complications of this condition is anemia, which results from deficient erythropoietin production and inadequate regulation of iron metabolism. This study aimed to analyze the main treatments used for anemia in patients with CKD, focusing on hypoxia-inducible factor prolyl hydroxylase inhibitors (HIF-PHIs) and erythropoiesis-stimulating agents (ESAs). This is an integrative literature review, structured according to the PICO strategy (Patient, Intervention, Comparison, and Outcome). The guiding question was: "In patients with CKD, are HIF-PHI inhibitors more effective than ESAs in treating anemia in terms of increasing hemoglobin levels?" The search was conducted in the PubMed database using descriptors in Portuguese, English, and Spanish. Inclusion criteria comprised studies published within the last five years involving patients with CKD-related anemia, whether or not dependent on dialysis, that directly compared HIF-PHIs and ESAs. Studies lacking a clear methodology, published outside the specified period, or unavailable in full were excluded. The initial screening identified 418 publications, of which seven met the eligibility criteria and were included after full-text review. Most of the selected articles were meta-analyses of randomized clinical trials and were evaluated for methodological quality based on the Qualis/CAPES classification. The extracted data included the effects of the treatments on hemoglobin levels, hepcidin concentrations, and the main adverse events reported. The results indicated that HIF-PHIs promoted more significant increases in hemoglobin levels and greater reductions in hepcidin levels compared to ESAs. No significant differences in safety profiles were observed between the treatments. We conclude that HIF-PHIs represent a promising therapeutic alternative for the treatment of anemia in CKD, especially in non-dialysis-dependent patients, although they are still undergoing clinical trials.