From the Guidelines
Anemia in patients with chronic kidney disease (CKD) not on dialysis should be managed with novel anemia therapies, such as vadadustat, when hemoglobin levels fall below 10 g/dL, with a target range of 10-11 g/dL, as this approach has been shown to improve quality of life and potentially slow CKD progression, as demonstrated in recent studies 1.
Management Strategies
The management of anemia in CKD patients not on dialysis involves the use of erythropoiesis-stimulating agents (ESAs) or novel therapies, such as vadadustat, which have been shown to improve hemoglobin levels and quality of life.
- Common ESAs include epoetin alfa, darbepoetin alfa, or methoxy polyethylene glycol-epoetin beta, with starting doses and titration schedules as recommended in the literature 1.
- Iron supplementation is essential before and during ESA therapy, with oral iron as first-line treatment, switching to intravenous iron if oral therapy is ineffective or not tolerated, as recommended by guidelines 1.
Monitoring and Adjustment
Regular monitoring of hemoglobin levels every 2-4 weeks during initiation and monthly thereafter is necessary, along with iron studies, to adjust ESA doses and avoid rapid hemoglobin increases, which can increase cardiovascular risks.
- ESA doses should be adjusted gradually to maintain a target hemoglobin range, with careful monitoring of iron status and adjustment of iron supplementation as needed.
Novel Therapies
Recent studies have demonstrated the efficacy and safety of novel anemia therapies, such as vadadustat, in CKD patients not on dialysis, with improved hemoglobin levels and quality of life, as shown in the PRO2 TECT study 1.
- These novel therapies offer an alternative to traditional ESAs, with the potential for improved outcomes and reduced cardiovascular risks.
From the FDA Drug Label
In controlled trials, patients with chronic kidney disease (CKD) experienced greater risks for death, serious adverse cardiovascular reactions, and stroke when administered erythropoiesis-stimulating agents (ESAs) to target a hemoglobin level of greater than 11 g/dL [see Warnings and Precautions (5.1)]. Use the lowest RETACRIT dose sufficient to reduce the need for red blood cell (RBC) transfusions [see Warnings and Precautions (5.1)]. Evaluate the iron status in all patients before and during treatment. Administer supplemental iron therapy when serum ferritin is less than 100 mcg/L or when serum transferrin saturation is less than 20%. Correct or exclude other causes of anemia (e. g., vitamin deficiency, metabolic or chronic inflammatory conditions, bleeding, etc.) before initiating RETACRIT.
The management strategies for anemia in patients with Chronic Kidney Disease (CKD) not on dialysis include:
- Using the lowest dose of erythropoiesis-stimulating agents (ESAs) sufficient to reduce the need for red blood cell (RBC) transfusions
- Evaluating and managing iron stores and nutritional factors, including administering supplemental iron therapy when necessary
- Correcting or excluding other causes of anemia before initiating ESA therapy
- Monitoring hemoglobin levels weekly until stable and sufficient to minimize the need for RBC transfusion 2 Key considerations:
- Targeting a hemoglobin level of greater than 11 g/dL may increase the risk of death, serious adverse cardiovascular reactions, and stroke
- Supplemental iron therapy is often required in patients with CKD during ESA therapy