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Exploring Emerging Strategies in the Management of Anemia in Chronic Kidney Disease
Anemia is a common complication of chronic kidney disease (CKD), which represents a major worldwide burden on public health, particularly in aging populations. Anemia affects the majority of patients with advanced CKD and is associated with increased cardiovascular risk, hospitalization, and mortality. Anemia in CKD is predominantly because of a relative deficiency in erythropoietin production by the kidney, although concomitant functional and/or absolute iron deficiency and systemic and local inflammation also frequently contribute to its induction and maintenance.
The current standard of care for anemia secondary to CKD is the use of injectable erythropoiesis-stimulating agents (ESAs), alone or in combination with intravenous or oral iron supplementation. While ESAs have been shown to be effective in treating anemia for many patients with CKD, they have some well-recognized limitations. Thus, alternative treatments that limit erythropoietin exposure would be useful additions to the therapeutic armamentarium for anemia in CKD. Stabilization of hypoxia-inducible factor (HIF) via prolyl-hydroxylase (PH) domain inhibition represents a potentially promising new therapeutic approach to treat anemia secondary to CKD. Activation of HIF orchestrates a coordinated response to promote erythropoiesis through the stimulation of endogenous erythropoietin production, increased uptake of iron, and mobilization of iron stores. Indeed, several HIF-PH inhibitors are currently in development for the treatment of anemia in CKD, and available clinical trial data suggest that HIF-PH inhibitors offer a number of advantages over ESAs.
In this activity, based on a live symposium, experts offer insight into best practices regarding the treatment of CKD-associated anemia and the important emerging evidence for HIF-PH inhibitors in settings where conventional ESA therapy is often of limited efficacy. Foundational guidance is combined with a discussion of real cases.
This activity has been designed to meet the educational needs of clinical pharmacists and other clinicians involved in the management of CKD.
Upon completion of this activity, participants will be able to:
- Describe the clinical consequences of anemia in patients with CKD
- Recognize the rationale for targeting HIF stabilization with HIF-PH inhibitors as a treatment strategy for anemia as a result of CKD
- Summarize current clinical trial data regarding the efficacy and safety of HIF-PH inhibitors for the treatment of anemia because of CKD in both nondialysis-dependent and dialysis-dependent patients
- Identify patients with anemia because of CKD who would likely derive benefit from treatment with a HIF-PH inhibitor
Providership, Credit, and Support
This CPE activity is jointly provided by Medical Learning Institute, Inc. and PVI, PeerView Institute for Medical Education.
This activity is supported by an educational grant from AstraZeneca Pharmaceuticals LP in collaboration with FibroGen.
Continuing Pharmacy Education
The Medical Learning Institute, Inc. (MLI) designates this continuing education activity for 1.5 contact hours (0.15 CEUs) of the Accreditation Council for Pharmacy Education.
Universal Activity Number: 0468-9999-19-022-H01-P
Type of Activity: Knowledge
December 31, 2019
December 30, 2020
Jay B. Wish, MD
Professor of Clinical Medicine
Chief Medical Officer for Dialysis
Indiana University Health
Jay B. Wish, MD, has a financial interest/relationship or affiliation in the form of:
Consultant and/or Advisor for Akebia Therapeutics; AstraZeneca; Otsuka America Pharmaceutical, Inc.; Rockwell Medical; and Vifor Pharma Management Ltd.
Speakers Bureau participant with Akebia Therapeutics and AstraZeneca.
Anil K. Agarwal, MD, FASN
Professor of Medicine
The Ohio State University College of Medicine
Anil K. Agarwal, MD, FASN, has a financial interest/relationship or affiliation in the form of:
Consultant and/or Advisor for AstraZeneca and Rockwell Medical.
Grant/Research Support from Akebia Therapeutics.
Thomas C. Dowling, PharmD, PhD, FCCP
Professor and Assistant Dean, College of Pharmacy
Director, Office of Research and Sponsored Programs
Ferris State University
Big Rapids, Michigan
Thomas C. Dowling, PharmD, PhD, FCCP, has a financial interest/relationship or affiliation in the form of:
Speakers Bureau participant with AstraZeneca.
Planning Committee Disclosures
Teresa Haile, RPh, MBA, Lead Pharmacy Planner, MLI, has nothing to disclose.
The planners from Medical Learning Institute, Inc., the accredited provider, and PeerView Institute for Medical Education, the joint provider, do not have any financial relationships with an ACCME-defined commercial interest related to the content of this accredited activity during the past 12 months unless listed below.
Content/Peer Reviewer Disclosures
The following Content/Peer Reviewer has nothing to disclose:
Shelley Chun, PharmD
Disclosure of Unlabeled Use
This educational activity may contain discussions of published and/or investigational uses of agents that are not indicated by the FDA. The planners of this activity do not recommend the use of any agent outside of the labeled indications. The opinions expressed in the educational activity are those of the faculty and do not necessarily represent the views of the planners. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.
Participants have an implied responsibility to use the newly acquired information to enhance patient outcomes and their own professional development. The information presented in this activity is not meant to serve as a guideline for patient management. Any procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this activity should not be used by clinicians without evaluation of their patient's conditions and possible contraindications and/or dangers in use, review of any applicable manufacturer's product information, and comparison with recommendations of other authorities.
Method of Participation
There are no fees for participating in or receiving credit for this accredited activity. For information on applicability and acceptance of continuing education credit for this activity, please consult your professional licensing board.
A statement of credit will be issued only upon receipt of a completed activity evaluation form and will be emailed to you upon completion. You will receive your certificate from email@example.com. If you have questions regarding the receipt of your emailed certificate, please contact via email at info@PeerView.com.
For Pharmacists: Upon receipt of the completed activity evaluation form, you will receive an email from firstname.lastname@example.org within 2 weeks with a link and directions to submit your credit to the NABP CPE Monitor Service. MLI will accept your completed evaluation form for up to 30 days and will report your participation to the NABP only if you provide your NABP e-Profile number and date of birth. Within 6 weeks, view your participation record at the NABP website: mycpemonitor.net.
About This CPE Activity
PVI, PeerView Institute for Medical Education, and Medical Learning Institute, Inc. are responsible for the selection of this activity's topics, the preparation of editorial content, and the distribution of this activity. Our activities may contain references to unapproved products or uses of these products in certain jurisdictions. The preparation of PeerView activities is supported by educational grants subject to written agreements that clearly stipulate and enforce the editorial independence of PVI and Medical Learning Institute, Inc.
The materials presented here are used with the permission of the authors and/or other sources. These materials do not necessarily reflect the views of PeerView or any of its partners, providers, and/or supporters.