Targeting Hypoxia-Inducible Factor in the Management of Anemia in Patients with CKD: An Update on Emerging Therapies




Patients with chronic kidney disease (CKD) and anemia experience substantially increased burdens to morbidity and mortality. Erythropoiesis-stimulating agents (ESA) and iron supplementation are mainstays of therapy, yet ESA has been associated with increased cardiovascular adverse events. Increased understanding of hypoxia-inducible factors (HIFs) has led to the development of novel therapies, hypoxia-iducible factor prolyl hydroxylase inhibitors (HIF-PHIs) that work by simulating hypoxia in cells, thereby stimulating EPO synthesis and improving iron metabolism and mobilization through reduced hepcidin levels.

Three HIF-PHIs (i.e. roxadustat, vadadustat, and daprodustat) are currently undergoing late-stage development, with one agent already approved to treat anemia in patients with CKD in China. To be best prepared to incorporate these agents into clinical practice once FDA-approved, nephrologists must be educated on the pathophysiological mechanisms involved in CKD-related anemia and recent outcomes from clinical trials evaluating these agents in patients with CKD. This educational activity will address these knowledge gaps among nephrologists, and application of this knowledge will improve outcomes for patients with anemia and CKD.


Jay B. Wish, MD
Professor of Clinical Medicine
Division of Medicine
Indiana University School of Medicine
Indianapolis, Indiana


Release date: September 30, 2020
Expiration date: September 30, 2021
Estimated time to complete activity: 0.75 hour(s)



This educational activity is intended for nephrology fellows, attendings, and trainees.


Upon completion of this educational activity, participants should be able to:

  • Summarize the prevalence of and burden associated with anemia in patients with CKD, particularly those who are hyporesponsive to ESA therapy
  • Articulate the pathogenic mechanisms involved in anemia associated with CKD, including the roles of inflammation, hepcidin, and the HIF pathway
  • Interpret outcomes from clinical trials evaluating the use of HIF-PHIs to treat anemia in patients with CKD
  • Review the potential place of HIF-PHIs in the management of anemia in patients with CKD

There are no fees for participating and receiving CME credit for this activity. During the period of September 30, 2020 through September 30, 2021, participants must:

  • Read the learning objectives and faculty disclosures
  • Complete the pretest
  • Study the educational activity
  • Complete the posttest and the evaluation form

A statement of credit will be issued only upon receipt of a completed activity evaluation form and a completed posttest with a score of 66% or better.




Integrity Continuing Education is accredited with commendation by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.


Integrity Continuing Education designates this enduring activity for a maximum of 0.75 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.


For information about ACCME accreditation of this activity, please contact Integrity Continuing Education at (855) 835-4004 or


Integrity Continuing Education requires instructors, planners, managers, and other individuals who are in a position to control the content of this activity to disclose any real or apparent conflict of interest they may have as related to the content of this activity. All identified conflicts of interest are thoroughly vetted by Integrity Continuing Education for fair balance, scientific objectivity of studies mentioned in the materials or used as the basis for content, and appropriateness of patient care recommendations.

The following faculty/planners reported the financial relationships or relationships to products or devices they or their spouse/life partner have with commercial interests related to the content of these CME activities:

Jay B. Wish, MD
Consulting Fees: AstraZeneca, Akebia, Vifor, Rockwell Medical
Speakers’ Bureaus: AstraZeneca, Akebia

The Integrity Continuing Education, Inc. planners and managers have nothing to disclose.


This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the FDA. Integrity Continuing Education, Inc. and AstraZeneca 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 any organization associated with this activity. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.


When you participate in an online educational activity sponsored by Integrity Continuing Education, Inc., you will be asked for your name, degree(s), affiliation(s), street address, telephone number, fax number, and…(continued)

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The information provided at this activity is for continuing education purposes only and is not meant to substitute for the independent medical judgment of a physician relative to diagnostic and treatment options of a specific patient’s medical condition.


Provided by Integrity Continuing Education, Inc.


Supported by an educational grant from AstraZeneca.

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