Controversies in optimal anemia management: conclusions from a Kidney Disease: Improving Global Outcomes (KDIGO) Conference

Babitt, Jodie L.; Eisenga, Michele F.; Kshirsagar, Abhijit V.; Levin, Adeera; Locatelli, Francesco; Małyszko, Jolanta; Swinkels, Dorine W.; Tarng, Der‐Cherng; Cheung, Michael; Jadoul, Michel; Winkelmayer, Wolfgang C.; Drüeke, Tilman B.; Abu‐Alfa, Ali K.; Afsar, Barış; Pai, Amy Barton; Besarab, Anatole; Moore, Geraldine Biddle; Casadevall, Nicole; Cases, Aleix; Francisco, Angel de; Eckardt, Kai‐Uwe; Fishbane, Steven; Fried, Linda F.; Ganz, Tomas; Ginzburg, Yelena; Gómez, Rafael; Goodnough, Lawrence T.; Hamano, Takayuki; Hanudel, Mark R.; Hao, Chuan‐Ming; Iseki, Kunitoshi; Ix, Joachim H.; Johansen, Kirsten L.; Ketteler, Markus; Kövesdy, Csaba P.; Leaf, David E.; Macdougall, Iain C.; Massy, Ziad A.; McMahon, Lawrence P.; Minutolo, Roberto; Nakanishi, Takeshi; Nemeth, Elizabeta; Obrador, Gregorio T.; Parfrey, Patrick S.; Park, Hyeong Cheon; Pécoits-Filho, Roberto; Robinson, Bruce M.; Roger, Simon D.; Shah, Yatrik; Spinowitz, Bruce; Tanaka, Tetsuhiro; Tsukamoto, Yusuke; Tungsanga, Kriang; Walther, Carl P.; Wang, Angela Yee-Moon; Wolf, Myles

doi:10.1016/j.kint.2021.03.020

Cited by 116 publications

(112 citation statements)

References 202 publications

(260 reference statements)

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“…HIF-PHIs could hold the potential to change the scene of renal anemia treatment in the near future, if they demonstrate a noninferior safety profile compared to classic ESAs. Renal anemia treatment with a particular focus on iron was the matter of “Optimal Anemia Management: Conclusions from KDIGO Conference in December 2019” in the recent publication in 2021 [ 150 ]. We did explore new and ongoing controversies, together with possible implications for changes of the current KDIGO anemia guideline, and proposals of research agenda.…”

Section: Discussionmentioning

confidence: 99%

Current Status of Renal Anemia Pharmacotherapy—What Can We Offer Today

Borawski

Małyszko

Kwiatkowska

et al. 2021

JCM

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Chronic kidney disease (CKD) is one of the fastest-growing major causes of death internationally. Better treatment of CKD and its complications is crucial to reverse this negative trend. Anemia is a frequent complication of CKD and is associated with unfavorable clinical outcomes. It is a devastating complication of progressive kidney disease, that negatively affects also the quality of life. The prevalence of anemia increases in parallel with CKD progression. The aim of this review is to summarize the current knowledge on therapy of renal anemia. Iron therapy, blood transfusions, and erythropoietin stimulating agents are still the mainstay of renal anemia treatment. There are several novel agents on the horizon that might provide therapeutic opportunities in CKD. The potential therapeutic options target the hepcidin–ferroportin axis, which is the master regulator of iron homeostasis, and the BMP-SMAD pathway, which regulates hepcidin expression in the liver. An inhibition of prolyl hydroxylase is a new therapeutic option becoming available for the treatment of anemia in CKD patients. This new class of drugs stimulates the synthesis of endogenous erythropoietin and increases iron availability. We also summarized the effects of prolyl hydroxylase inhibitors on iron parameters, including hepcidin, as their action on the hematological parameters. They could be of particular interest in the out-patient population with CKD and patients with ESA hyporesponsiveness. However, current knowledge is limited and still awaits clinical validation. One should be aware of the potential risks and benefits of novel, sophisticated therapies.

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Section: Discussionmentioning

confidence: 99%

Current Status of Renal Anemia Pharmacotherapy—What Can We Offer Today

Borawski

Małyszko

Kwiatkowska

et al. 2021

JCM

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show abstract

“…However, these parameters have been questioned and are an area of active review. 8 Since inflammation, which is highly prevalent in CKD, can raise ferritin and lower transferrin concentration in plasma, this compromises the applicability of these standard diagnostic tests. Alternative measures such as reticulocyte hemoglobin content and percentage of hypochromic RBCs have been proposed.…”

Section: Functional Vs Absolute Iron Deficiencymentioning

confidence: 99%

Recent and Emerging Therapies for Iron Deficiency in Anemia of CKD: A Review

Bazeley

Wish

2022

American Journal of Kidney Diseases

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“…The main advantage of iron-based binders is their ability to (in theory) simultaneously reduce phosphate uptake and to supplement iron. This is relevant since iron deficiency is common in both CKD and after kidney transplantation [ 163 , 164 ]; moreover, iron deficiency might also increase FGF23 production [ 165 ]. At this time, no studies have been conducted involving a head-to-head comparison with traditional phosphate binders regarding their FGF23-lowering effect.…”

Section: Treatments Targeting Hyperphosphatemia and Increased Fgf23mentioning

confidence: 99%

Phosphate and fibroblast growth factor 23 in diabetes

et al. 2021

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Diabetes is associated with a strongly elevated risk of cardiovascular disease, which is even more pronounced in patients with diabetic nephropathy. Currently available guideline-based efforts to correct traditional risk factors are only partly able to attenuate this risk, underlining the urge to identify novel treatment targets. Emerging data point towards a role for disturbances in phosphate metabolism in diabetes. In this review, we discuss the role of phosphate and the phosphate-regulating hormone fibroblast growth factor 23 (FGF23) in diabetes. We address deregulations of phosphate metabolism in patients with diabetes, including diabetic ketoacidosis. Moreover, we discuss potential adverse consequences of these deregulations, including the role of deregulated phosphate and glucose as drivers of vascular calcification propensity. Finally, we highlight potential treatment options to correct abnormalities in phosphate and FGF23. While further studies are needed to more precisely assess their clinical impact, deregulations in phosphate and FGF23 are promising potential target in diabetes and diabetic nephropathy.

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Controversies in optimal anemia management: conclusions from a Kidney Disease: Improving Global Outcomes (KDIGO) Conference

Cited by 116 publications

References 202 publications

Current Status of Renal Anemia Pharmacotherapy—What Can We Offer Today

Current Status of Renal Anemia Pharmacotherapy—What Can We Offer Today

Recent and Emerging Therapies for Iron Deficiency in Anemia of CKD: A Review

Phosphate and fibroblast growth factor 23 in diabetes

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