Haemoglobin change
(LS mean change from baseline)
Difference0.14 g/dL
95% CI
−0.1304
to 0.4202
Prespecified
non-inferiority
met
Why dialysis changes the anaemia picture
High anaemia burden
Stage 5 CKD has a high prevalence of moderate to severe anaemia.
Blood loss
Blood loss during dialysis from the circuit and sampling.
Inflammation & infection
Chronic inflammation and infections can increase hepcidin levels.
Iron restriction
Iron may be present in the body but less available for red blood cell production.
Reduced EPO
Kidneys produce less erythropoietin, leading to reduced red blood cell production.
DREAM-D study design
392 patients
38 centres across India
Randomised, open-label, active-controlled
24 weeks
Desidustat oral tablets vs epoetin alfa injection
Target haemoglobin in the study: 10–12 g/dL
DREAM-D results (24-week evaluation period)
Haemoglobin responders
(Patients achieving target Hb 10–12 g/dL)
59.22%
Desidustat
48.37%
Epoetin alfa
p = 0.0382
Safety
The safety profile of desidustat was comparable with epoetin alfa.
No new or increased risks were observed versus epoetin in the study.
Results are from the DREAM-D phase III study. Individual results may vary.
Read DREAM-D studyStarting-dose pathway (per approved prescribing information¹)
New to ESA therapy
Start Desidustat
100 mg
three times weekly
Converting from epoetin / darbepoetin / methoxy polyethylene glycol-epoetin beta
Select starting dose based on previous ESA dose
Choose starting dose
100 mgthree times weekly(lower previous ESA dose)
125 mgthree times weekly(moderate previous ESA dose)
150 mgthree times weekly(higher previous ESA dose)
Administration
Give after completion of dialysis session
Monitoring
Reassess haemoglobin every 4 weeks and adjust dose
Do not consume any food 1 hour before and 2 hours after taking OXEMIA®.
Doses to be taken 2 days apart (examples below), not 4 days apart.
Dosing calendar examples (take 2 days apart)
Option 1: Mon / Wed / Fri
MTWTFS–––
Option 2: Tue / Thu / Sat
MTWFSS–––
No food 1 hour before dose
No food 2 hours after dose
Take after completion of dialysis session.
Guideline context (South Asia HIF-PHI Guideline²)
Desidustat might be offered as an alternative to ESAs for dialysis-dependent patients with CKD who do not prefer ESAs.
- Patients should be iron replete before initiation.
- Effectiveness and safety evidence was judged very low certainty.
- More large, multicentre and long-term studies are recommended.
- Practical considerations: oral administration and no cold-chain storage; however, HD patients often receive IV ESA during visits, and polypharmacy can be an important consideration.
Related evidence and resources
Real-world evidence (Dialysis subgroup)
Gulati et al. (2026)³Multicentre retrospective study in CKD patients including dialysis recipients.
See dialysis outcomes in routine practice
Evidence synthesis (NDD-CKD systematic review)
Tyagi et al. (2025)⁴Low certainty evidence for key clinical outcomes with HIF-PH inhibitors in non-dialysis CKD.
Review the systematic evidence
Emerging refractory anaemia research
PRCA case series (2026)⁵Desidustat in EPO-induced PRCA: small case series, research context only.
Go to research librarySafety and next steps
DREAM-D safety data
Access adverse events tables, serious adverse events and study safety details.
View safety tablesComplete safety information
For full safety profile, contraindications, precautions, drug interactions and monitoring recommendations.
View safety informationFull prescribing information
View approved indication, dosing, administration, warnings and precautions.
Download PI (PDF)Medical information for HCPs
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