Anaemia of Chronic Disease in Chronic Kidney Disease Discussion Paper

Anaemia of Chronic Disease in Chronic Kidney Disease Discussion Paper

Anemia is a very common complication in chronic kidney disease or CKD. It normally becomes worse as the estimated glomerular filtration rate or eGFR declines. According to Portolés et al. (2021), anemia is twice as prevalent in patients with CKD as it is in the general population. The purpose of this short paper is to look at why and how anemia occurs in CKD and how it is managed.

How and Why

The kidneys produce a number of biochemical molecules that perform diverse physiological functions. Amongst these is the hormone referred to as endogenous erythropoietin (EPO). With declining kidney function, there is a reduction in circulating endogenous EPO. The function of EPO is to stimulate the bone marrow to produce erythrocytes (Hammer & McPhee, 2018; Jameson et al., 2018). With little to no circulating endogenous EPO, fewer red blood cells are produced and the patient starts experiencing chronic anemia. This anemia is also usually accompanied by chronic iron deficiency. Anaemia of Chronic Disease in Chronic Kidney Disease Discussion Paper

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Management/ Treatment 

The aim of treatment in this case is to provide the missing necessary raw materials needed by the bone marrow to manufacture erythrocytes. In this case these are elemental iron and erythropoietin. Currently, treatment of anemia of CKD is made up of erythropoiesis-stimulating agents (ESA) and iron supplementation. However, research continues on newer and more effective treatment options, since the above two modalities also have their disadvantages .The newer drugs for treating anemia in CKD are referred to as HIF-prolyl-hydroxylase inhibitors or HIF-PHIs (Portolés et al., 2021). They are all oral medications and include roxadustat, molidustat, daprodustat, and vadadustat. All of them are however still undergoing phases of clinical trials to establish efficacy and safety. Anaemia of Chronic Disease in Chronic Kidney Disease Discussion Paper

References

Hammer, D.G., & McPhee, S.J. (Eds). (2018). Pathophysiology of disease: An introduction to clinical medicine, 8^th ed. McGraw-Hill Education.

Jameson, J.L., Fauci, A.S., Kasper, D.L., Hauser, S.L., Longo, D.L., & Loscalzo, J. (Eds) (2018). Harrison’s principles of internal medicine, 20^th ed. McGraw-Hill Education.

Portolés, J., Martín, L., Broseta, J.J., & Cases, A. (2021). Anemia in chronic kidney disease: From pathophysiology and current treatments, to future agents. Frontiers in Medicine, 8(642296), 1-14. Anaemia of Chronic Disease in Chronic Kidney Disease Discussion Paper