Reviewing Traditional and Novel Approaches to Managing Anemia of Chronic Kidney Disease

Abstract

Anemia is a common complication of chronic kidney disease (CKD). If not managed appropriately, anemia can be highly debilitating and potentially life-threatening for CKD patients. Various treatments have been developed to alleviate CKD-associated anemia, with the main goals of restoring circulating iron, promoting erythropoiesis, and downregulating hepcidin. Mainstream treatment options include iron supplements, erythropoiesis-stimulating agents (ESAs), hepcidin antagonists, and blood transfusion. However, the therapeutic efficacy of current CKD anemia treatments is hindered by extensive adverse effects, most notably iron overload and ESA resistance. HIF-PH (hypoxia-induced factor prolyl hydroxylase) inhibitors are a novel class of orally bioavailable drugs for CKD anemia. HIF-PH inhibitors adopt a distinct mechanism, stimulating erythropoiesis via transcriptional regulation of the hypoxia-activated erythropoietin (EPO) gene. This review summarizes existing and emerging therapeutic strategies for CKD-associated anemia, with particular emphasis on HIF-PH inhibitors and their clinical potential and risks.