Therapeutics of managing reduced red cell mass associated with chronic kidney disease – is there a case for earlier intervention?

Elliott, Jonathan

Abstract

Reduced red cell mass is a poor prognostic indicator in chronic kidney disease (CKD) patients. Whilst overt anaemia impacts on the quality of life of patients with CKD, lowered red cell mass may also compromise oxygen delivery to proximal tubular cells and contribute to progressive kidney injury. Epidemiological data from cats with CKD support this hypothesis although controlled interventional studies involving drugs which raise red cell mass in trials designed to test this hypothesis are lacking in both human and veterinary medicine. Recombinant analogues of erythropoietin (EPO) are currently standard of care for human CKD patients where low red cell mass impacts on their quality of life. Resistance to EPO is encountered in 20 to 40% of patients treated, probably due to functional iron deficiency, reflecting the difficulties of managing iron deficiency associated with the chronic inflammation of CKD. Similar issues are likely faced in managing anaemia in feline CKD although published data on the use of human EPO analogues is limited as such treatment in cats risks antibody formation resulting in red cell aplasia and transfusion dependency and so is reserved for late stage cases only. This paper reviews the recent alternative therapeutic approach to increase red cell mass using HIF-prolyl hydroxylase inhibitors, explains their mode of action and theoretical advantages over EPO analogues in the context of iron metabolism. The results of human clinical trials and the potential benefit of adopting this approach in feline CKD patients are discussed.

Citation

Elliott, J. (in press). Therapeutics of managing reduced red cell mass associated with chronic kidney disease – is there a case for earlier intervention?. Journal of Veterinary Pharmacology and Therapeutics, https://doi.org/10.1111/jvp.13127

• Journal Article Type: Review
• Acceptance Date: Mar 30, 2023
• Online Publication Date: Apr 10, 2023
• Deposit Date: Mar 30, 2023
• Journal: Journal of Veterinary Pharmacology and Therapeutics
• Print ISSN: 0140-7783
• Electronic ISSN: 1365-2885
• Publisher: American Academy of Veterinary Pharmacology and Therapeutics
• Peer Reviewed: Peer Reviewed
• DOI: https://doi.org/10.1111/jvp.13127
• Keywords: Hypoxia-inducible factor; Prolyl hydroxylase inhibitors; iron metabolism