Advances in Anemia Management: Changing Treatment Paradigms
ISN Academy. Hao C. 04/24/19; 272231 Topic: Chronic kidney disease
Chuan-Ming Hao
Chuan-Ming Hao
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Learning Objectives
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Given the central role of abnormal EPO and iron homeostasis, current treatment paradigms center on the replacement of these in the form of various ESAs and iron (oral or IV in CKD, and mostly IV in ESRD). This paradigm has numerous flaws. ESA administration results in massively increased levels of circulating EPO, and while effective in raising Hgb concentrations in 90% of individuals, clinical trials examining its long-term outcomes have indicated negative effects when targeting normalization of blood hemoglobin levels. Combined with their high cost, this has resulted in a much more conservative approach, with significantly lower target hemoglobin levels, and with an increase in iron utilization. The long-term effects of the increased usage of iron (especially IV iron) remain unknown, but there are concerns about potential adverse effects. HIF-PHIs are a novel class of therapeutics which are in clinical development for the treatment of anemia in CKD and in ESRD. Studies suggests that HIF-PHIs increase endogenous EPO production to appropriate physiologic levels, like those seen after blood loss or in high-altitude acclimation and normalize iron homeostasis by decreasing functional iron deficiency. Phase 2 and 3 clinical trials have shown that HIF-PHIs are effective and safe treatments of anemia in patients with CKD and ESRD.
Expected Learning Outcomes:
Following are learning outcomes expected from the audience at the conclusion of this symposium.
  • Emphasis will be placed on these learning objectives and changes in practice. Examine the prevalence of and risk factors for hyperkalemia and its associated prognosis across healthcare settings
  • Appraise the recent shifts in treatment patterns that have occurred in the management of anemia in CKD
  • Describe commonly applied therapies for anemia and hyperkalemia and understand their advantages and disadvantages.
  • Become familiar with novel treatments for hyperkalemia and anemia, and their role in changing therapeutic paradigms optimizing management.
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