This review describes the current state of anemia management with erythropoietin (EPO)-stimulating agents and iron supplementation in both chronic kidney disease and dialysis patients, with a focus on novel therapies.
We review the benefits and risks of EPO-stimulating agents, focusing on health-related quality of life and the uncertainties regarding optimal iron utilization in patients with kidney disease. We discuss novel therapies for iron supplementation including iron-based phosphate binders and dialysate iron delivery as well as alternatives to EPO-stimulating agents including hypoxia-inducible factor prolyl hydroxylase inhibitors.
Individualization of hemoglobin targets using EPO-stimulating agents and iron supplementation may be considered in younger, healthier patients with kidney disease to improve health-related quality of life. Optimal iron utilization in kidney disease patients is unclear, but novel iron base phosphate binders and dialysate iron delivery may play a role in intravenous iron avoidance and its potential complications. Phase 3 randomized controlled trials of hypoxia-inducible factor prolyl hydroxylase inhibitors are ongoing and are promising new alternatives to EPO-stimulating agents and their known adverse effects.
aSection of Nephrology, Department of Medicine, McMaster University, Hamilton, Ontario
bChronic Disease Innovation Center, Seven Oaks General Hospital
cSection of Nephrology, Department of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
Correspondence to Navdeep Tangri, MD, PhD, Chronic Disease Innovation Center, Seven Oaks General Hospital, 2300 McPhillips Street, 2PD13, Winnipeg, MB, Canada R2V 3M3. Tel: +1 204 631 3837; e-mail: firstname.lastname@example.org