Jay B. Wish, MD - Exploring Emerging Strategies in the Management of Anemia in Chronic Kidney Disease

Go online to PeerView.com/ETT860 to view the activity, download slides and practice aids, and complete the post-test to earn credit. Anemia is a common complication of chronic kidney disease (CKD), which represents a major worldwide burden on public health, particularly in aging populations. Anemia affects the majority of patients with advanced CKD and is associated with increased cardiovascular risk, hospitalization, and mortality. Anemia in CKD is predominantly because of a relative deficiency in erythropoietin (EPO) production by the kidney, although concomitant functional and/or absolute iron deficiency and systemic and local inflammation also frequently contribute to its induction and maintenance. The current standard of care for anemia secondary to CKD is the use of injectable erythropoiesis-stimulating agents (ESAs), alone or in combination with intravenous or oral iron supplementation. While ESAs have been shown to be effective in treating anemia for many patients with CKD, they have some well-recognized limitations. Thus, alternative treatments that limit EPO exposure would be useful additions to the therapeutic armamentarium for anemia in CKD. Stabilization of hypoxia-inducible factor (HIF) via prolyl-hydroxylase (PH) domain inhibition represents a potentially promising new therapeutic approach to treat anemia secondary to CKD. Activation of HIF orchestrates a coordinated response to promote erythropoiesis through the stimulation of endogenous EPO production, increased uptake of iron, and mobilization of iron stores. Indeed, several HIF-PH inhibitors are currently in development for the treatment of anemia in CKD, and available clinical trial data suggest that HIF-PH inhibitors offer a number of advantages over ESAs. In this activity, based on a live symposium, experts offer insight into best practices regarding the treatment of CKD-associated anemia and the important emerging evidence for HIF-PH inhibitors in settings where conventional ESA therapy is often of limited efficacy. Foundational guidance is combined with a discussion of real cases. Upon completion of this activity, participants will be able to: Describe the clinical consequences of anemia in patients with chronic kidney disease (CKD), Recognize the rationale for targeting hypoxia-inducible factor (HIF) stabilization with HIF prolyl-hydroxylase (PH) inhibitors as a treatment strategy for anemia as a result of CKD, Summarize current clinical trial data regarding the efficacy and safety of HIF-PH inhibitors for the treatment of anemia because of CKD in both nondialysis-dependent and dialysis-dependent patients, Identify patients with anemia because of CKD who would likely derive benefit from treatment with a HIF-PH inhibitor