# Cerebral Infarction After Switching From Roxadustat to Daprodustat in a Patient With Renal Anemia

## TL;DR

A patient with renal anemia experienced a cerebral infarction after switching from roxadustat to daprodustat, raising concerns about hemoglobin changes and cardiovascular risks.

## Contribution

Highlights a potential risk of switching HIF-PH inhibitors in patients with renal anemia and cardiovascular vulnerability.

## Key findings

- A patient developed cerebral infarction three weeks after switching HIF-PH inhibitors.
- Hemoglobin levels increased during the switch, possibly contributing to the infarction.
- The case suggests caution when changing HIF-PH inhibitors in high-risk patients.

## Abstract

Renal anemia is generally caused by a decrease in the production of erythropoietin in kidney due to renal dysfunction, and this may be associated with the increase in mortality and cardiovascular events in addition to subjective symptoms such as fatigue and wobbliness.

We report a case of an 87-year-old man with type 2 diabetes, hypertension, and dyslipidemia who had received roxadustat (a hypoxia-inducible factor (HIF) prolyl hydroxylase (PH) inhibitor) for renal anemia due to diabetic nephropathy and in whom roxadustat was switched to daprodustat (another HIF-PH inhibitor) due to the onset of central hypothyroidism. About three weeks after this change, the patient developed acute asymptomatic cerebral infarction with an elevation of hemoglobin (Hb). It is unclear if the change to daprodustat was involved in the onset of cerebral infarction. However, this case suggests that particular caution should be paid to unexpected acute elevation of Hb after a change from one HIF-PH inhibitor to another, especially in a patient at high risk for cardiovascular events.