Understanding anaemia of CKD

Anaemia is a common feature of chronic kidney disease,1 and one of the hallmarks of advanced CKD.

The prevalence of anaemia increases as CKD progresses, from 42.5% at stage 3b CKD to 83.7% in people with stage 5 CKD.

Anaemia of CKD was previously attributed primarily to decreased production of erythropoietin (EPO).

It is now known to be caused by a number of factors, including:

Reduced oxygen sensing in the kidney

Reduced erythropoietin production

Chronic inflammation resulting in increased hepcidin levels

Iron deficiency

As CKD progresses:

• EPO production decreases, leading to a reduction in red blood cells and haemoglobin
• Hepcidin levels are elevated due to inflammation and decreased renal excretion
• Elevated hepcidin leads to a reduction in absorption, recycling and mobilisation of iron

CKD, chronic kidney disease; EPO, erythropoietin.

Treatment Challanges

A specialist's view

Professor Anjon Banerjee on kidney diseases

Management of anaemia of CKD can often be sub-optimal.

Current treatment of anaemia of CKD is mainly based on iron supplements and ESAs (erythropoiesis-stimulating agents).

These treatments target individual factors and not the underlying pathology of anaemia of CKD.

When ESA treatment commences, a state of “functional” iron deficiency may develop as a result of elevated hepcidin levels and increased iron demand, blunting the therapeutic response to ESA.

CKD, chronic kidney disease; ESA, erythropoiesis-stimulating agent.

The need for an alternate treatment option

The limitations of current therapies have highlighted the need for alternative treatment options.

Advances in the study of CKD-associated anaemia have focused on the pathophysiology of anaemia with the hope of discovering more targeted and physiological therapies.

The discovery of hypoxia-inducible factors (HIFs) has led to the development of an alternate category of drugs that stimulate erythropoiesis by activating the HIF pathway.

CKD, chronic kidney disease; HIF, hypoxia-inducible factor.

EVZ_2022_0252_UK / August 2022