Abstract

Naga Manikanta Madduri*, Yash Pal, Sagarika Bandi, Margi Desai and Mansi Mistry

ABSTRACT

Chronic kidney disease (CKD) is a major global health issue, with anemia being afrequent and debilitating complication. The impaired production of erythropoietin(EPO) in CKD reduces red blood cell production, contributing to anemia, especiallyin advanced stages, where prevalence can reach up to 90%. Iron deficiency,common in CKD, worsens anemia due to disruptions in iron metabolism, includingelevated hepcidin levels that hinder iron absorption and release from stores, furtherlimiting its availability for red blood cell production. Recent treatment options forCKD-related anemia include erythropoiesis-stimulating agents (ESAs) andhypoxia-inducible factor prolyl hydroxylase inhibitors (HIF-PHIs), both aimed atenhancing red blood cell production. ESAs, like epoetin and darbepoetin, haveimproved anemia management, with long-acting formulations offering convenienceand stable hemoglobin levels. However, challenges such as "therapeutic inertia,"where patients do not receive adequate ESA or iron supplementation despite clearindications, and concerns about cardiovascular risks at higher ESA doses, persist.Effective anemia management in CKD requires early detection, ironsupplementation, and careful ESA use. Addressing anemia alongside controllingblood pressure and diabetes can enhance patient outcomes, improve quality of life,and reduce healthcare costs. This review examines the pathophysiology of anemiain CKD and evaluates current therapeutic approaches.