Will you use vadadustat in place of an ESA in treating anemia of chronic kidney disease?

Vadadustat is approved by the FDA only for patients who have been on dialysis for at least 3 months. It is not approved for patients with CKD not on dialysis. Its efficacy and safety are comparable to that of ESAs. I would consider using vadadustat in two patient populations: those on home dialysis who may have issues with ESA administration (don't like needles/injections, obtaining and cold storing the drug, travel to a clinic if home administration is not possible, etc,) and those in-center hemodialysis patients who have an unsatisfactory response to ESAs (failure to achieve/maintain target Hb level, high ESA dose). Once we are comfortable with using vadadustat, its use might expand to other dialysis populations if it is cost-competitive ...

I would use traditional ESA due to their known safety profile and reserve agent for an unresponsive patient. With more data, will likely change.