OBJECTIVES

Congestive heart failure (CHF) is a common comorbidity of chronic kidney disease (CKD) that has been associated with poorer CKD prognosis and increased costs. The prevalence of CHF increases as CKD progresses in severity. Iron deficiency also affects outcomes in heart failure among patients with CKD. CHF events in CKD were assessed as part of an endpoint in the development program for roxadustat, which is an oral hypoxia-inducible factor prolyl hydroxylase inhibitor that stimulates a coordinated erythropoietic response that includes the increase of plasma endogenous erythropoietin levels and reduction of hepcidin.

METHODS

Data from six pivotal, randomized studies in the roxadustat global phase 3 program were pooled; three studies (n=4270 patients) comparing roxadustat to placebo in patients with non-dialysis-dependent chronic kidney disease (NDD CKD) and, three (n=3880 patients) comparing roxadustat to epoetin alfa in patients with dialysis-dependent chronic kidney disease (DD CKD). CHF hospitalization was assessed as a component of the composite MACE-plus endpoint, which also included myocardial infarction, stroke, unstable angina hospitalization, and all-cause mortality. Costs of CHF were estimated using data from the 2016 Healthcare Cost and Utilization Project and were translated to 2020 dollars using the Consumer Price Index inflation calculator. ICD-10 codes were used to identify CHF events.

RESULTS

The average total cost of a CHF episode, which included the event and other treatment-related costs, was $14,358, while the average cost per CHF event was $12,763. In the NDD CKD study population, the proportion of patients on roxadustat who experienced hospitalization due to CHF was similar to patients on placebo (HR=0.89; 95% CI: 0.72, 1.12). In the DD CKD study population, fewer patients on roxadustat were hospitalized due to CHF compared to patients on epoetin alfa (HR=0.73; 95% CI: 0.58, 0.94).

CONCLUSIONS

Treatment with roxadustat for anemia of CKD may mitigate CHF hospitalization rates and decrease associated healthcare costs.