Kidney Week Educational Symposia-New Insights in Iron Deficiency Anemia Among Patients with Non-Dialysis CKD

Video Transcription

Video Summary

The session introduces two talks on iron deficiency and anemia management in non-dialysis CKD and frames them around hypoxia-inducible factor (HIF) biology. HIF is a universal cellular hypoxia response that regulates thousands of genes, including erythropoietin (EPO), angiogenesis (VEGF), and glycolysis. Under normal oxygen, HIF-α is hydroxylated by prolyl hydroxylases and degraded via the VHL complex; hypoxia (or prolyl hydroxylase inhibition) stabilizes HIF, increasing EPO and improving iron availability partly by lowering hepcidin. While HIF activation can treat CKD anemia, excessive HIF activity (e.g., VHL disease) promotes renal cancer, motivating development of HIF-2α antagonists.<br /><br />Dr. Haase reviews iron balance and the roles of absolute vs functional iron deficiency in CKD, emphasizing inflammation-driven hepcidin elevation, reduced ferroportin, and impaired iron mobilization. He highlights limitations of ferritin/TSAT and under-monitoring and under-treatment of iron deficiency in practice. Hepcidin is central and therapeutically targetable (e.g., hepcidin binders, BMP/IL-6 pathway modulation), and HIF-PH inhibitors also improve iron handling.<br /><br />Dr. Nangaku summarizes evidence that iron repletion improves outcomes and ESA responsiveness, discusses oral (ferric citrate, ferric maltol) and IV iron, and reviews HIF-PH inhibitor trials showing efficacy and hepcidin reduction. He stresses careful iron monitoring because iron depletion during HIF-PH therapy may contribute to thromboembolic risk.

Asset Subtitle

Moderators: Monique Cho

Speakers:

Introduction - Monique Cho
Impaired Iron Homeostasis in CKD: Updates on Pathophysiology and Diagnosis - Volker Haase
Advances in Management of CKD-Related Iron Deficiency Anemia - Masaomi Nangaku

Meta Tag

Date 11/4/2021

Pathway 1 Chronic Kidney Disease

Session ID 408410

Session Type ES - Educational Symposium

Keywords

chronic kidney disease anemia

non-dialysis CKD

iron deficiency (absolute vs functional)

hypoxia-inducible factor (HIF) pathway

prolyl hydroxylase inhibitors (HIF-PH inhibitors)

hepcidin regulation and ferroportin

erythropoietin (EPO) and ESA responsiveness

intravenous and oral iron therapy

VHL complex and HIF-2α antagonists