Kidney Week Educational Symposia-Updates on Therapeutic Options for Anemia in Kidney Diseases

Video Transcription

Video Summary

The session focuses on newer treatments for anemia in chronic kidney disease (CKD) and end-stage kidney disease (ESRD), emphasizing that anemia care—especially in the U.S.—is often suboptimal and undertreated, worsening morbidity and quality of life and leading to frequent transfusions. Speakers review existing anemia guidelines (KDIGO 2012 and regional updates) and highlight key uncertainties, particularly the “gap” in evidence for optimal hemoglobin targets in the 9–12 g/dL range, reinforcing the need for shared decision-making based on patient symptoms and preferences.<br /><br />Using international DOPPS/CKDopps observational data, Dr. Robinson shows inadequate monitoring of hemoglobin and iron indices and substantial undertreatment: many patients with hemoglobin <10 or low TSAT do not receive timely iron or ESA therapy, and many start dialysis with low hemoglobin followed by aggressive ESA/iron dosing during the high-mortality early dialysis period.<br /><br />Dr. Gupta explains the hypoxia-inducible factor prolyl hydroxylase inhibitors (HIF-PHIs), oral agents that stimulate endogenous erythropoietin and improve iron metabolism (including lowering hepcidin). Trials demonstrate strong hemoglobin efficacy comparable to ESAs, but U.S. FDA reviews raised safety concerns (e.g., thrombosis, seizures, hyperkalemia; mixed cardiovascular signals), contributing to lack of U.S. approval for some agents.<br /><br />Internationally, HIF-PHIs are approved in multiple regions, generally positioned as alternatives to ESAs (not routine replacements), with guidance to avoid widespread switching and to ensure ongoing safety surveillance. Discussion stresses individualized risk–benefit counseling, particularly for non-dialysis CKD where oral therapy is most attractive but safety signals may be stronger.

Asset Subtitle

Moderators: Fredric Finkelstein

Introduction - Fredric Finkelstein
Management of Anemia in Nondialysis CKD: Current Recommendations - Bruce Robinson
Efficacy and Cardiovascular Safety of Hypoxia-Inducible Factor-Prolyl Hydroxylase Inhibitors - Nupur Gupta

Support is provided by an educational grant from GlaxoSmithKline.

Meta Tag

Date 11/3/2022

Pathway 1 CKD Non-Dialysis

Pathway 2

Session ID 438079

Session Type ES - Educational Symposium

Keywords

anemia management

chronic kidney disease (CKD)

end-stage kidney disease (ESRD)

hemoglobin targets 9–12 g/dL

KDIGO 2012 anemia guidelines

DOPPS/CKDopps observational data

iron indices monitoring (TSAT, ferritin)

erythropoiesis-stimulating agents (ESAs)

HIF prolyl hydroxylase inhibitors (HIF-PHIs)

FDA safety concerns (thrombosis, cardiovascular risk)