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However, few studies assess HIF-PHIs in patients with elevated ERI who do not yet require hemodialysis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This multicenter, prospective, observational study utilized data from the Reach-J study to explore the characteristics of Japanese patients with anemia in CKD (stage G3b\u20135) who switched from ESAs to HIF-PHIs. We also examined changes in hemoglobin levels following switching.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      We assessed 447 patients who continued ESA treatment and 34 patients who switched from ESAs to HIF-PHIs (mean age: 74 years). Patients who switched had numerically higher mean erythropoietin resistance index (ERI) and numerically lower hemoglobin than those who continued ESA treatment. Mean hemoglobin levels increased following switching (9.9\u00a0g\/dL vs. 10.6\u00a0g\/dL;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.004). After 3 months, hemoglobin levels increased in both high and low ERI subgroups (high ERI: 9.7\u00a0g\/dL to 11.1\u00a0g\/dL, low ERI: 10.6\u00a0g\/dL to 11.8\u00a0g\/dL). Hemoglobin levels did not notably decrease before or after the start of hemodialysis in two HIF-PHI-treated patients.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Patients who switched to HIF-PHIs had low hemoglobin levels and high ERI compared with those who continued ESA treatment. Both high ERI and low ERI groups had increased hemoglobin levels after switching.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial registration<\/jats:title>\n                    <jats:p>UMIN Clinical Trials Registry (UMIN000022145, registration date: 30 April 2016).<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s12882-026-05036-3","type":"journal-article","created":{"date-parts":[[2026,5,25]],"date-time":"2026-05-25T06:15:53Z","timestamp":1779689753000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Patient characteristics and treatment efficacy after switching to hypoxia-inducible factor-prolyl hydroxylase inhibitors from erythropoiesis-stimulating agents in non-dialysis-dependent chronic kidney disease patients: the Reach-J CKD cohort study"],"prefix":"10.1186","volume":"27","author":[{"given":"Kunihiro","family":"Yamagata","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tomohiro","family":"Ohigashi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chie","family":"Saito","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hirayasu","family":"Kai","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ryoya","family":"Tsunoda","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Reiko","family":"Okubo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Masahide","family":"Kondo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Haruka","family":"Ishii","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Masami","family":"Inuzuka","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kenji","family":"Harada","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ichiei","family":"Narita","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hirokazu","family":"Okada","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Takashi","family":"Wada","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shoichi","family":"Maruyama","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Junichi","family":"Hoshino","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,5,25]]},"reference":[{"key":"5036_CR1","doi-asserted-by":"publisher","first-page":"52","DOI":"10.1007\/s12325-020-01524-6","volume":"38","author":"RM Hanna","year":"2021","unstructured":"Hanna RM, Streja E, Kalantar-Zadeh K. 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Korean J Intern Med. 2024;39:488\u2013500. https:\/\/doi.org\/10.3904\/kjim.2023.520.","journal-title":"Korean J Intern Med"}],"container-title":["BMC Nephrology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12882-026-05036-3","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12882-026-05036-3.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12882-026-05036-3.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T00:02:01Z","timestamp":1784505721000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1186\/s12882-026-05036-3"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,25]]},"references-count":40,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,12]]}},"alternative-id":["5036"],"URL":"https:\/\/doi.org\/10.1186\/s12882-026-05036-3","relation":{},"ISSN":["1471-2369"],"issn-type":[{"value":"1471-2369","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,25]]},"assertion":[{"value":"9 January 2026","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"4 May 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"25 May 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee of Tsukuba University at which the studies were conducted (IRB approval number H27-199) and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards. All patients provided written informed consent prior to participation in the study.","order":1,"name":"Ethics","label":"Ethics approval and consent to participate","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Not applicable.","order":2,"name":"Ethics","label":"Consent for publication","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Kunihiro Yamagata has received research grants from Mitsubishi Tanabe Pharma Corporation and received honoraria for lectures from Astellas Pharma Inc. Hirayasu Kai has received honoraria for lectures from Kyowa Kirin Co., Ltd. Ryoya Tsunoda has received honoraria from Nippon Boehringer Ingelheim Co., Ltd., Kyowa Kirin Co., Ltd., Ono Pharmaceutical Co., Ltd., AstraZeneca K.K., Otsuka Pharmaceutical Co., Ltd., and Daiichi Sankyo Co., Ltd. Hirokazu Okada has received research grants from Bayer Yakuhin, Ltd. and Chugai Pharmaceutical Co., Ltd.; and received honoraria for lectures from Kyowa Kirin Co., Ltd., Nippon Boehringer Ingelheim Co., Ltd., Eli Lilly Japan K.K., AstraZeneca K.K., Ono Pharmaceutical Co., Ltd., and Bayer Yakuhin, Ltd. Shoichi Maruyama has received research grants from ROHTO Pharmaceutical Co., Ltd., Mitsubishi Tanabe Pharma Corporation, Nippon Zenyaku Kogyo Co., Ltd., and Nipro Corporation; received honoraria for lectures from Alexion Pharmaceuticals, Inc., Mitsubishi Tanabe Pharma Corporation, AstraZeneca K.K., Ono Pharmaceutical Co., Ltd., Kyowa Kirin Co., Ltd., Torii Pharmaceutical Co., Ltd., Otsuka Pharmaceutical Co., Ltd., and Nippon Boehringer Ingelheim Co., Ltd.; received donations from Otsuka Pharmaceutical Co., Ltd. and Torii Pharmaceutical Co., Ltd.; and is a board member of the Japanese Society of Nephrology. Junichi Hoshino has received honoraria from AstraZeneca K.K., Torii Pharmaceutical Co., Ltd., Kyowa Kirin Co., Ltd., Nippon Boehringer Ingelheim Co., Ltd., Astellas Pharma Inc., and Mitsubishi Tanabe Pharma Corporation. Haruka Ishii, Masami Inuzuka, and Kenji Harada are employees of Kyowa Kirin Co., Ltd. Tomohiro Ohigashi, Chie Saito, Reiko Okubo, Masahide Kondo, Ichiei Narita, and Takashi Wada have no conflicts of interest to declare.","order":3,"name":"Ethics","label":"Competing interests","group":{"name":"EthicsHeading","label":"Declarations"}}],"article-number":"434"}}