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Cardiovascular & Hematological Agents in Medicinal Chemistry

Editor-in-Chief

ISSN (Print): 1871-5257
ISSN (Online): 1875-6182

New Strategies for Managing Anemia of Chronic Kidney Disease

Author(s): Holger Schmid, Helmut Schiff l and Stephan R. Lederer

Volume 10, Issue 4, 2012

Page: [339 - 351] Pages: 13

DOI: 10.2174/187152512803530342

Price: $65

Abstract

Anemia is a prevalent and premature comorbidity in chronic kidney disease (CKD) and associated with multiple adverse clinical consequences including increased mortality. Today Erythropoiesis-stimulating agents (ESAs), together with iron supplementation, are the cornerstones of therapy for correcting anemia in CKD patients. As no generally accepted dosing algorithms for these agents exist, current recommendations prefer a partial but not complete anemia correction thereby favoring a more conservative and individualized ESA and iron dosing. Here we discuss in detail current evidence derived from large randomized trials about the proposed hemoglobin targets to aim at in CKD and End-Stage renal disease patients and report recent data from the thriving European market of biosimilar erythropoietins. We summarize promising investigational strategies including peginesatide and prolyl hydroxylase inhibitors for stabilization of the hypoxia inducible factor and provide a clinical review of novel high dose iron formulations like ferumoxytol or iron (III)-carboxymaltose. Taking these findings together, treatment strategies for anemia of CKD have got considerably more complicated so that a careful balance between maximization of patient`s quality of life while minimizing all risks associated with anemia treatment has become a major task of current nephrology.

Keywords: Anemia, biosimilars, chronic kidney disease, darbepoetin alfa, end-stage renal disease, erythropoiesis stimulating agents, ferritin, ferumoxytol, hepcidin, Hypoxia-inducible factor 1, iron, iron (III) – carboxymaltose, peginesatide, Prolyl hydroxylase inhibitors


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