Strategies for Managing Anemia in Chronic Kidney Disease

  • Blessy Biju Pharm D, St James College of Pharmaceutical Sciences, Chalakudy, Kerala. 2. St James College of Pharmaceutical Sciences (NAAC Accredited), St James Hospital Trust Pharmaceutical Research Centre (DSIR Recognized) Chalakudy, Kerala.
  • Adlin D'Cruz Pharm D, St James College of Pharmaceutical Sciences, Chalakudy, Kerala, India
  • Sneha Jiby Pharm D, St James College of Pharmaceutical Sciences, Chalakudy, Kerala, India
  • Melvin Devassy Pharm D, St James College of Pharmaceutical Sciences, Chalakudy, Kerala, India
  • Rosmin Jacob Assistant Professor, Department of Pharmacy Practice, St James College of Pharmaceutical Sciences, Chalakudy, Kerala, India

Abstract

Anemia is a common complication in chronic kidney disease (CKD) and is associated with decreased quality of life, deteriorating kidney function, increased illness, higher mortality rates, and elevated healthcare costs. Management of CKD-related anemia aims to enhance renal function (when feasible) and bolster red blood cell production. Anemia in chronic kidney disease (CKD) stems from a variety of factors, including reduced erythropoietin (EPO) production, inadequate iron availability or functionality, and inflammation leading to heightened levels of hepcidin, among other causes. Typical treatment for CKD-related anemia involves administering oral or intravenous iron supplements in conjunction with erythropoiesis-stimulating agents (ESAs). Over the past decade, erythropoiesis-stimulating agents (ESAs) have proven effective in boosting hemoglobin (Hb) levels for many patients. However, concerns about their safety, particularly regarding increased cardiovascular risk—especially at high doses and in hyporesponsive patients—have emerged. As a result, there's been a shift towards adopting more cautious Hb targets. Iron deficiency is widespread among CKD patients, particularly in those not undergoing dialysis. While iron supplementation has traditionally been used to support anemia management, there's growing recognition of the potential benefits of intravenous iron therapy, especially in the context of heart failure. HIF prolyl hydroxylase inhibitors are promising new drugs being clinically evaluated as alternatives to ESAs for anemia treatment in CKD patients. Initial data suggest they effectively boost endogenous erythropoietin production with potential benefits like lower peak concentrations, efficacy in inflamed patients, and improved iron utilization. However, further research is needed to confirm their safety and efficacy in the long term use.


Keywords: anemia, chronic kidney disease, erythropoiesis-stimulating agents, iron, HIF-prolyl-hydroxylase inhibitors

Keywords: anemia, chronic kidney disease, erythropoiesis-stimulating agents, iron, HIF-prolyl-hydroxylase inhibitors

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Author Biographies

Blessy Biju, Pharm D, St James College of Pharmaceutical Sciences, Chalakudy, Kerala. 2. St James College of Pharmaceutical Sciences (NAAC Accredited), St James Hospital Trust Pharmaceutical Research Centre (DSIR Recognized) Chalakudy, Kerala.

St James College of Pharmaceutical Sciences (NAAC Accredited), St James Hospital Trust Pharmaceutical Research Centre (DSIR Recognized) Chalakudy, Kerala, India

Adlin D'Cruz, Pharm D, St James College of Pharmaceutical Sciences, Chalakudy, Kerala, India

St James College of Pharmaceutical Sciences (NAAC Accredited), St James Hospital Trust Pharmaceutical Research Centre (DSIR Recognized) Chalakudy, Kerala, India

Sneha Jiby, Pharm D, St James College of Pharmaceutical Sciences, Chalakudy, Kerala, India

St James College of Pharmaceutical Sciences (NAAC Accredited), St James Hospital Trust Pharmaceutical Research Centre (DSIR Recognized) Chalakudy, Kerala, India

Melvin Devassy, Pharm D, St James College of Pharmaceutical Sciences, Chalakudy, Kerala, India

St James College of Pharmaceutical Sciences (NAAC Accredited), St James Hospital Trust Pharmaceutical Research Centre (DSIR Recognized) Chalakudy, Kerala, India

Rosmin Jacob, Assistant Professor, Department of Pharmacy Practice, St James College of Pharmaceutical Sciences, Chalakudy, Kerala, India

St James College of Pharmaceutical Sciences (NAAC Accredited), St James Hospital Trust Pharmaceutical Research Centre (DSIR Recognized) Chalakudy, Kerala, India

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Biju B, D’Cruz A, Jiby S, Devassy M, Jacob R. Strategies for Managing Anemia in Chronic Kidney Disease. JDDT [Internet]. 15Apr.2024 [cited 12Jul.2024];14(4):92-5. Available from: https://jddtonline.info/index.php/jddt/article/view/6501