Iron supplements concomitant with HIF-PHIs in the treatment of CKD anemia

Anemia is a common and important complication in patients with chronic kidney disease (CKD). Accordingly, the current treatment is based on erythropoiesis stimulating agents (ESAs) and iron. Hypoxia-inducible factor (HIF) prolyl hydroxylase domain (PHD) inhibitors (HIF-PHIs) have been developed to t...

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Main Authors: Xue Wang, Cuiting Wei, Delong Zhao, Xuefeng Sun, Fengge Zhu, Yan Mei, Qian Ma, Guangyan Cai, Xiangmei Chen, Ping Li
Format: Article
Language:English
Published: Karger Publishers 2023-08-01
Series:Kidney Diseases
Online Access:https://beta.karger.com/Article/FullText/533304
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author Xue Wang
Cuiting Wei
Delong Zhao
Xuefeng Sun
Fengge Zhu
Yan Mei
Qian Ma
Guangyan Cai
Xiangmei Chen
Ping Li
author_facet Xue Wang
Cuiting Wei
Delong Zhao
Xuefeng Sun
Fengge Zhu
Yan Mei
Qian Ma
Guangyan Cai
Xiangmei Chen
Ping Li
author_sort Xue Wang
collection DOAJ
description Anemia is a common and important complication in patients with chronic kidney disease (CKD). Accordingly, the current treatment is based on erythropoiesis stimulating agents (ESAs) and iron. Hypoxia-inducible factor (HIF) prolyl hydroxylase domain (PHD) inhibitors (HIF-PHIs) have been developed to treat renal anemia through a novel mechanism. HIF-PHIs increase EPO at physiologic blood concentrations and also improve the supply of hematopoietic iron. Iron is the main component of hemoglobin, and ensuring efficient iron metabolism is essential in the treatment of anemia. HIF-PHIs may have advantages in improving iron utilization and mobilization compared to ESAs. Most HIF-PHIs trials revealed a significant decline of hepcidin, increase transferrin level and total iron binding capacity in patients. From a clinical point of view, improvements in iron metabolism should translate into a reduction in the need for iron supplementation, although timely and comparative assessment of iron supplementation across studies are complicated due to the large variability in the iron regimen employed. This review summarizes the mechanism of HIF-PHIs on improved iron metabolism and the route of iron usage in the trials for dialysis-dependent CKD and non-dialysis CKD. And this review also makes an interpretation of the clinical practice guidelines in China and recommendation by Asia Pacific Society of Nephrology.
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spelling doaj.art-6cb4c7e9ac264d56b11b3dee57476d2a2023-09-07T07:56:39ZengKarger PublishersKidney Diseases2296-93572023-08-0110.1159/000533304533304Iron supplements concomitant with HIF-PHIs in the treatment of CKD anemiaXue WangCuiting WeiDelong ZhaoXuefeng SunFengge ZhuYan MeiQian MaGuangyan CaiXiangmei ChenPing LiAnemia is a common and important complication in patients with chronic kidney disease (CKD). Accordingly, the current treatment is based on erythropoiesis stimulating agents (ESAs) and iron. Hypoxia-inducible factor (HIF) prolyl hydroxylase domain (PHD) inhibitors (HIF-PHIs) have been developed to treat renal anemia through a novel mechanism. HIF-PHIs increase EPO at physiologic blood concentrations and also improve the supply of hematopoietic iron. Iron is the main component of hemoglobin, and ensuring efficient iron metabolism is essential in the treatment of anemia. HIF-PHIs may have advantages in improving iron utilization and mobilization compared to ESAs. Most HIF-PHIs trials revealed a significant decline of hepcidin, increase transferrin level and total iron binding capacity in patients. From a clinical point of view, improvements in iron metabolism should translate into a reduction in the need for iron supplementation, although timely and comparative assessment of iron supplementation across studies are complicated due to the large variability in the iron regimen employed. This review summarizes the mechanism of HIF-PHIs on improved iron metabolism and the route of iron usage in the trials for dialysis-dependent CKD and non-dialysis CKD. And this review also makes an interpretation of the clinical practice guidelines in China and recommendation by Asia Pacific Society of Nephrology.https://beta.karger.com/Article/FullText/533304
spellingShingle Xue Wang
Cuiting Wei
Delong Zhao
Xuefeng Sun
Fengge Zhu
Yan Mei
Qian Ma
Guangyan Cai
Xiangmei Chen
Ping Li
Iron supplements concomitant with HIF-PHIs in the treatment of CKD anemia
Kidney Diseases
title Iron supplements concomitant with HIF-PHIs in the treatment of CKD anemia
title_full Iron supplements concomitant with HIF-PHIs in the treatment of CKD anemia
title_fullStr Iron supplements concomitant with HIF-PHIs in the treatment of CKD anemia
title_full_unstemmed Iron supplements concomitant with HIF-PHIs in the treatment of CKD anemia
title_short Iron supplements concomitant with HIF-PHIs in the treatment of CKD anemia
title_sort iron supplements concomitant with hif phis in the treatment of ckd anemia
url https://beta.karger.com/Article/FullText/533304
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