What is the treatment for anemia in patients with kidney (renal) failure?

From the Guidelines

Martera (roxadustat) is a recommended treatment for anemia in patients with chronic kidney disease, including those with kidney failure, as it improves morbidity, mortality, and quality of life 1.

Key Considerations

• The treatment of anemia in chronic kidney disease (CKD) is crucial to improve survival, decrease morbidity, and increase quality of life 1.
• Martera works by stimulating the production of red blood cells by mimicking the body's natural response to low oxygen levels.
• The typical starting dose is 70 mg three times per week for dialysis patients or 100 mg three times per week for non-dialysis patients, with adjustments made based on hemoglobin response.
• Treatment is ongoing as kidney failure-related anemia is typically chronic.
• Patients should have their hemoglobin levels monitored regularly, typically every 2-4 weeks during dose adjustment and monthly thereafter.

Benefits and Risks

• Martera offers advantages over traditional erythropoietin-stimulating agents as it can be taken orally rather than by injection and may require less supplemental iron.
• Common side effects include hypertension, nausea, diarrhea, and increased risk of thrombotic events.
• Patients should report any symptoms of blood clots, severe headaches, or vision changes immediately.
• Martera should be used under close medical supervision as part of a comprehensive treatment plan for kidney disease.

Guideline Recommendations

• The 2012 KDIGO anemia guideline provides recommendations on the diagnosis and treatment of anemia in CKD, including the use of iron agents, erythropoiesis-stimulating agents (ESAs), and red cell transfusions 1.
• The 2021 KDIGO conference concluded that anemia and iron deficiency are prevalent in patients with CKD and associated with poor outcomes, and that practice patterns have shifted toward reduced ESA use and increased iron supplementation 1.

From the FDA Drug Label

Patients with CKD and an insufficient hemoglobin response to ESA therapy may be at even greater risk for cardiovascular reactions and mortality than other patients. In controlled clinical trials of patients with cancer, epoetin alfa and other ESAs increased the risks for death and serious adverse cardiovascular reactions. The design and overall results of the 3 large trials comparing higher and lower hemoglobin targets are shown in Table 1.

The treatment of anemia in patients with kidney failure using epoetin alfa may increase the risk of cardiovascular reactions and mortality. The use of epoetin alfa in patients with chronic kidney disease (CKD) has been associated with an increased risk of stroke, myocardial infarction, and death.

• Key points:
  • Epoetin alfa may increase the risk of cardiovascular reactions and mortality in patients with CKD.
  • The risk of stroke, myocardial infarction, and death may be higher in patients with CKD who receive epoetin alfa.
  • Patients with CKD and an insufficient hemoglobin response to ESA therapy may be at greater risk for cardiovascular reactions and mortality. 2

From the Research

Martera Treatment for Anemia in Kidney Failure

• There is no direct mention of "Martera" in the provided studies, however, the studies discuss the treatment of anemia in patients with kidney failure using erythropoiesis-stimulating agents (ESAs) 3, 4, 5, 6, 7.
• ESAs, such as epoetin alfa, epoetin beta, darbepoetin alfa, and continuous erythropoietin receptor activator, are effective in correcting renal anemia and increasing hemoglobin levels 3.
• The choice of ESA should take into account their pharmacokinetics and pharmacodynamics, administration route, and economic issues 3.
• Hyporesponse to ESAs is a significant clinical challenge, and management involves treating underlying causes such as iron deficiency and inflammation, and optimizing iron status and dialysis modality 4.
• New therapies, such as HIF-PH inhibitors, have the potential to address fundamental aspects of ESA hyporesponse and provide a new therapeutic option in patients with anemia of CKD 4.

Erythropoiesis-Stimulating Agents (ESAs)

• ESAs are the main drugs for correcting anemia in patients with chronic kidney disease (CKD) 3, 5, 6, 7.
• The use of ESAs in the management of anemia of CKD is associated with improved quality of life, increased survival, and decreased progression of renal failure 5.
• However, correction of anemia to hemoglobin levels greater than 12 g/dL appears to increase the risk of adverse cardiac outcomes and progression of kidney disease in some patients 5.

Treatment of Anemia in Kidney Failure

• Anemia is a common complication of chronic kidney disease, and its management is crucial to improve quality of life and prevent target-organ damage 6.
• The treatment of anemia in patients with kidney failure involves the use of ESAs, iron supplements, and RBC transfusion in severe cases 4, 6.
• The goal of treatment is to achieve a hemoglobin level of 11-12 g/dL, while minimizing the risk of adverse outcomes 3.