Kidney Week Educational Symposia-Anemia in CKD and ESKD: From Epidemiology and Pathophysiology to Current Treatments

Video Transcription

Video Summary

This Kidney Week 2023 educational symposium reviewed anemia across chronic kidney disease (CKD), end-stage kidney disease (ESKD), and kidney transplantation, covering epidemiology, mechanisms, and treatment.<br /><br />Epidemiology data from NHANES (1999–2018) estimated anemia prevalence at ~25% among stage 3–5 non–dialysis-dependent CKD (about 4.5 million people), rising sharply with worsening eGFR: anemia increases from ~17% in stage 3 to ~66% in stage 5, and severe anemia (Hb <10) from ~1% to >12%. Risk factors included age >75, female sex, Black race, diabetes, and hypertension. Iron studies are under-checked and iron deficiency undertreated; ESA use in eligible advanced CKD patients was very low. Anemia severity correlates with higher risk of kidney replacement therapy, cardiovascular events, and death. In ESKD, anemia is nearly universal (~95% hemodialysis; ~90% peritoneal dialysis), with far greater IV iron use in hemodialysis.<br /><br />Mechanisms discussed included reduced erythropoietin (EPO) production due to kidney injury–driven transformation of EPO-producing cells, plus absolute and functional iron deficiency driven by hepcidin (elevated by inflammation and reduced renal clearance). HIF–prolyl hydroxylase inhibitors (HIF-PHIs) stimulate endogenous EPO and may improve iron handling; trial data on reduced IV iron needs were mixed. SGLT2 inhibitors consistently raise hemoglobin (~0.5–0.8 g/dL), possibly by lowering renal oxygen consumption and restoring EPO production.<br /><br />Treatment emphasized individualized care in CKD-ND: prioritize diagnosing and treating iron deficiency early (oral or IV), reserve ESAs for persistent Hb <10 when benefits outweigh risks. In dialysis, protocolized care with proactive IV iron repletion (supported by the PIVOTAL trial) reduces transfusions and major cardiovascular events without increasing infection. Daprodustat is an FDA-approved oral HIF-PHI option for dialysis anemia with similar hemoglobin control and cardiovascular safety to ESAs. Q&A addressed cancer risk uncertainty with HIF-PHIs, IV iron avoidance during active infection, and maintaining conservative hemoglobin targets (generally 10–11).

Asset Subtitle

Moderator(s): Neeraj Sharma

Presentation(s):

Introduction: Overview of the Epidemiology of Anemia in CKD - Neeraj Sharma
Mechanisms of Anemia in Kidney Diseases - Kirsten Johansen
Optimal Anemia Management in CKD and ESKD - Daniel Coyne

Support is provided by an educational grant from GSK.

Meta Tag

Date 11/2/2023

Pathway 1 CKD Non-Dialysis

Session ID 465002

Session Type ES - Educational Symposium

Keywords

Kidney Week 2023

anemia in chronic kidney disease

end-stage kidney disease dialysis anemia

kidney transplant anemia

NHANES anemia prevalence

erythropoietin deficiency

hepcidin and functional iron deficiency

iron supplementation oral vs IV

erythropoiesis-stimulating agents (ESAs)

HIF-prolyl hydroxylase inhibitors (daprodustat)