title: Emerging drugs for the treatment of kidney disease-induced anemia.
abstract: BACKGROUND
  Anemia has been remained one of the most characteristic and visible manifestations of chronic renal failure. Correction of anemia requires two main treatment strategies: increased stimulation of erythropoiesis, and maintenance of an adequate iron supply to the bone marrow.
  
  
  METHODS
  Erythropoiesis activating agents became a mainstay in the treatment of renal anemia for more than 25 years. Recently, there have been several attempts to introduce new drugs to stimulate erythropoiesis or affect the hepcidin-ferroportin pathway. Orally available hypoxia-inducible factor (HIF) stabilizing compounds are attractive alternatives. They not only increase hemoglobin, but also suppress hepcidin production and improve iron availability. Novel iron preparations, may also help to ameliorate anemia, with acceptable safety profile and other beneficial properties such a phosphate binding.
  
  
  CONCLUSIONS
  One should be aware of potential risks and benefits of novel sophisticated therapies and their role in the management of renal anemia remain to be established. In particular HIF stabilizers needs to be proven safe, or even safer than ESAs, in large long-term safety studies testing hard end points, due its ubiquitous nature and the regulation of variety of biological processes potentially leading to unexpected side effects. Besides safety, cost-effectiveness appears the major issue in the modern world, including nephrology.
authors.affiliation: a 2nd Department of Nephrology and Hypertension with Dialysis Unit , Medical University , Bialystok , Poland.|b 1st Department of Nephrology , Medical University , Bialystok , Poland.
authors.forename: Jolanta
authors.initials: J
authors.lastname: Malyszko
authors.affiliation: a 2nd Department of Nephrology and Hypertension with Dialysis Unit , Medical University , Bialystok , Poland.|b 1st Department of Nephrology , Medical University , Bialystok , Poland.
authors.forename: Jacek S
authors.initials: JS
authors.lastname: Malyszko
mesh_terms: D000740:Anemia / Q000188:drug therapy* / Q000209:etiology; D000818:Animals; D051792:Basic Helix-Loop-Helix Proteins / Q000378:metabolism; D015195:Drug Design; D006397:Hematinics / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use; D006801:Humans; D051793:Hypoxia-Inducible Factor 1 / Q000378:metabolism; D058085:Iron Compounds / Q000008:administration & dosage / Q000009:adverse effects; D007676:Kidney Failure, Chronic / Q000150:complications*; D000099162:Endothelial PAS Domain-Containing Protein 1
chemical_list: D051792:Basic Helix-Loop-Helix Proteins; D006397:Hematinics; D051793:Hypoxia-Inducible Factor 1; D058085:Iron Compounds; D000099162:Endothelial PAS Domain-Containing Protein 1
keywords: Chronic kidney disease; HIF stabilizers; dialysis; erythropoietin; hepcidin; iron; renal anemia