scholarly journals The evolving science of anemia management in chronic kidney disease

2021 ◽  
Vol 11 (1) ◽  
pp. 1-2
Author(s):  
Ziad A. Massy ◽  
Tilman B. Drueke
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Anemia Management

scholarly journals An Update on the Controversies in Anemia Management in Chronic Kidney Disease: Lessons Learned and Lost

Anemia ◽  
2011 ◽  
Vol 2011 ◽  
pp. 1-5 ◽  
Author(s):  
Geoffrey Teehan ◽  
Robert L. Benz
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Randomized Trials ◽  
Lessons Learned ◽  
Patients With Diabetes ◽  
Anemia Management ◽  
Erythropoietin Deficiency ◽  
Stage Renal Disease ◽  
End Stage

Background. Erythropoietin deficiency and anemia occur in Chronic Kidney Disease (CKD) and may be treated with Erythropoietin Stimulating Agents (ESAs). The optimal hemoglobin, in non-End Stage Renal Disease CKD, is controversial.Methods. We review three recent randomized trials in anemia in CKD: CHOIR, CREATE, and TREAT.Results. CHOIR (N=1432) was terminated early with more frequent death and cardiovascular outcomes in the higher Hb group (HR 1.34: 95% C.I. 1.03–1.74,P=.03). CREATE (N=603) showed no difference in primary cardiovascular endpoints. Stroke was more common in the higher Hb group (HR 1.92; 95% C.I. 1.38–2.68;P<.001) in TREAT (N=4038).Conclusions. There is no benefit to an Hb outside the 10–12 g/dL range in this population. To avoid transfusions and improve Quality of Life, ESAs should be used cautiously, especially in patients with Diabetes, CKD, risk factors for stroke, and ESA resistance.

scholarly journals Evaluation of Anemia Management by Algorithms in Patients with Chronic Kidney Disease Who Are Not Receiving Dialysis

2011 ◽  
Vol 64 (2) ◽  
Author(s):  
Marianna Leung ◽  
Jenelle Rogers ◽  
Monica Beaulieu ◽  
Adeera Levin ◽  
Shelley Burnett ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Anemia Management

scholarly journals Anemia management in chronic kidney disease

2010 ◽  
Vol 78 ◽  
pp. S3-S9 ◽  
Author(s):  
Steven Fishbane ◽  
Allen R. Nissenson
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Anemia Management

scholarly journals Targeting Hypoxia-Inducible Factors for the Treatment of Anemia in Chronic Kidney Disease Patients

2017 ◽  
Vol 45 (3) ◽  
pp. 187-199 ◽  
Author(s):  
Francesco Locatelli ◽  
Steven Fishbane ◽  
Geoffrey A. Block ◽  
Iain C. Macdougall
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Iron Metabolism ◽  
Treatment Options ◽  
Prolyl Hydroxylase ◽  
Hypoxia Inducible Factors ◽  
Anemia Management ◽  
Safety Considerations ◽  
Hif Pathway ◽  
Hif Prolyl Hydroxylase

Background: Anemia, a common complication of chronic kidney disease (CKD), has previously been attributed primarily to decreased production of erythropoietin. More recently, it has become apparent that the etiology of anemia involves several other factors, most notably dysfunctional iron metabolism, mediated via increased hepcidin activity and reduced clearance. Current management of anemia in patients with advanced CKD is based on erythropoiesis-stimulating agents and iron supplementation, along with red blood cell transfusions when necessary; however, safety considerations associated with these therapies highlight the need to pursue alternative treatment options targeting other mechanisms such as hypoxia-inducible factors (HIFs) that act as central regulators of erythropoiesis by coordinating a series of graded hypoxic responses. Summary: This review discusses the discovery of the HIF pathway and its regulation via HIF prolyl hydroxylase enzymes in the context of erythropoiesis and iron metabolism. The rationale for targeting this pathway and the clinical development of HIF prolyl hydroxylase inhibitors are reviewed, with a commentary on the potential implications of this class of agents in CKD anemia management. Key Messages: Pharmacologic activation of the HIF pathway results in a transient pseudo-hypoxic state that stimulates erythropoiesis in CKD patients with anemia. Results from clinical studies of a number of HIF prolyl hydroxylase inhibitors are increasingly available and provide support for the continued evaluation of the risk-benefit ratio of this novel therapeutic approach to the treatment of anemia in CKD.

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