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

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 devastatin...

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Autores principales: Borawski, Bartłomiej, Malyszko, Jacek Stanislaw, Kwiatkowska, Marlena, Malyszko, Jolanta
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8470821/
https://www.ncbi.nlm.nih.gov/pubmed/34575261
http://dx.doi.org/10.3390/jcm10184149
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author Borawski, Bartłomiej
Malyszko, Jacek Stanislaw
Kwiatkowska, Marlena
Malyszko, Jolanta
author_facet Borawski, Bartłomiej
Malyszko, Jacek Stanislaw
Kwiatkowska, Marlena
Malyszko, Jolanta
author_sort Borawski, Bartłomiej
collection PubMed
description 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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spelling pubmed-84708212021-09-27 Current Status of Renal Anemia Pharmacotherapy—What Can We Offer Today Borawski, Bartłomiej Malyszko, Jacek Stanislaw Kwiatkowska, Marlena Malyszko, Jolanta J Clin Med Review 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. MDPI 2021-09-15 /pmc/articles/PMC8470821/ /pubmed/34575261 http://dx.doi.org/10.3390/jcm10184149 Text en © 2021 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Review
Borawski, Bartłomiej
Malyszko, Jacek Stanislaw
Kwiatkowska, Marlena
Malyszko, Jolanta
Current Status of Renal Anemia Pharmacotherapy—What Can We Offer Today
title Current Status of Renal Anemia Pharmacotherapy—What Can We Offer Today
title_full Current Status of Renal Anemia Pharmacotherapy—What Can We Offer Today
title_fullStr Current Status of Renal Anemia Pharmacotherapy—What Can We Offer Today
title_full_unstemmed Current Status of Renal Anemia Pharmacotherapy—What Can We Offer Today
title_short Current Status of Renal Anemia Pharmacotherapy—What Can We Offer Today
title_sort current status of renal anemia pharmacotherapy—what can we offer today
topic Review
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8470821/
https://www.ncbi.nlm.nih.gov/pubmed/34575261
http://dx.doi.org/10.3390/jcm10184149
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