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Newer Way of Tackling Anemia in CKD

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Dr George T John, Australia    28 December 2018

  • Hypoxia-inducible factors (HIF) for the treatment of anemia in CKD patients - Current therapy: Erythropoiesis-stimulating agents (ESAs) and iron supplementation, RBC transfusions. New options: Targeting HIFs the central regulators of erythropoiesis by coordinating a series of graded hypoxic responses. Pharmacological activation of the HIF pathway causes a transient pseudo-hypoxic state stimulating erythropoiesis in CKD patients with anemia. HIF prolyl hydroxylase inhibitors (PHIs) are increasingly available and are being clinically tested.
  • HIF-PHIs in clinical development: Roxadustat, vadadustat, molidustat and daprodustat.
  • HIF stabilizers - Benefits: Renal erythropoietin (EPO) producing cells transform into myofibroblasts and promote fibrosis in injured kidneys and they can transform back into their native state with augmentation of HIF levels; Oral route of administration; Efficacy even in iron-depleted and increased inflammatory states; More physiologic simulation of endogenous EPO secretion.

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