Changing the paradigms for the treatment of chronic kidney disease
Authors: Daniel W. Coyne, Csaba P. Kovesdy
Journal: Kidney International Supplements (2017)

Chronic kidney disease (CKD) is a worldwide public health problem. Although the relative risk of death for most communicable and noncommunicable diseases has improved worldwide, CKD is among the few disease states that have been associated with worsening mortality since 1990, and is now the 19th leading cause of global years of life lost.1GBD 2013 Mortality and Causes of Death CollaboratorsGlobal, regional, and national age-sex specific all-cause and cause-specific mortality for 240 causes of death, 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013.Lancet. 2015; 385: 117-171Abstract Full Text Full Text PDF PubMed Scopus (5408) Google Scholar Even in developed countries like the United States and United Kingdom, the incidence and prevalence of CKD and end-stage renal disease remain high, and are associated with very high morbidity and mortality, due primarily to complications of cardiovascular disease.2Coresh J. Selvin E. Stevens L.A. et al.Prevalence of chronic kidney disease in the United States.JAMA. 2007; 298: 2038-2047Crossref PubMed Scopus (3894) Google Scholar, 3Saran R. Li Y. Robinson B. et al.US Renal Data System 2015 Annual Data Report: epidemiology of kidney disease in the United States.Am J Kidney Dis. 2016; 67 (Svii, S1–Svii, 305)Abstract Full Text Full Text PDF Scopus (367) Google Scholar, 4Ansell D. Roderick P. Udayaraj U. et al.Survival of incident RRT patients in the UK (chapter 12).Nephrol Dial Transplant. 2007; 22: vii155-vii164PubMed Google Scholar Notwithstanding the role of traditional cardiovascular risk factors in patients with CKD and end-stage renal disease, the extremely high rate of cardiovascular complications in these populations cannot be simply ascribed to the effects of more severe hypertension, obesity, or hypercholesterolemia; these are in fact often associated with lower mortality in patients with kidney diseases.5Kovesdy C.P. Bleyer A.J. Molnar M.Z. et al.Blood pressure and mortality in U.S. veterans with chronic kidney disease: a cohort study.Ann Intern Med. 2013; 159: 233-242Crossref PubMed Scopus (160) Google Scholar, 6Lu J.L. Kalantar-Zadeh K. Ma J.Z. et al.Association of body mass index with outcomes in patients with CKD.J Am Soc Nephrol. 2014; 25: 2088-2096Crossref PubMed Scopus (175) Google Scholar, 7Kovesdy C.P. Anderson J.E. Kalantar-Zadeh K. Inverse association between lipid levels and mortality in men with chronic kidney disease who are not yet on dialysis: effects of casemix and the malnutrition-inflammation-cachexia syndrome.J Am Soc Nephrol. 2007; 18: 304-311Crossref PubMed Scopus (124) Google Scholar CKD and end-stage renal disease are characterized by the progressive development of a multitude of abnormalities, such as electrolyte disorders, mineral and bone disorders, metabolic acidosis, or anemia; all of which have been shown to be associated with adverse outcomes in patients with kidney disease, and that likely contribute (separately or in combination) to the observed cardiovascular morbidity and mortality seen in these patients.8Kalantar-Zadeh K. Abbott K.C. Kronenberg F. et al.Epidemiology of dialysis patients and heart failure patients.Semin Nephrol. 2006; 26: 118-133Abstract Full Text Full Text PDF PubMed Scopus (68) Google Scholar Although CKD is not a curable disease in the vast majority of cases, its metabolic and other complications are typically amenable to therapeutic interventions. Anemia and hyperkalemia represent 2 complications that have been commonly treated by nephrologists for decades, but with interventions that are not without serious side effects.9Wish J.B. Coyne D.W. Use of erythropoiesis-stimulating agents in patients with anemia of chronic kidney disease: overcoming the pharmacological and pharmacoeconomic limitations of existing therapies.Mayo Clin Proc. 2007; 82: 1371-1380Abstract Full Text Full Text PDF PubMed Scopus (28) Google Scholar, 10Kovesdy C.P. Management of hyperkalaemia in chronic kidney disease.Nat Rev Nephrol. 2014; 10: 653-662Crossref PubMed Scopus (128) Google Scholar Recent advancements in our understanding of disease pathophysiology and the development of novel therapeutic agents has led to a renewed emphasis on the treatment of anemia of CKD and hyperkalemia, and may lead to a change on our therapeutic paradigms for these conditions.11Gupta N. Wish J.B. Hypoxia-inducible factor prolyl hydroxylase inhibitors: a potential new treatment for anemia in patients with CKD.Am J Kidney Dis. 2017; 69: 815-826Abstract Full Text Full Text PDF PubMed Scopus (241) Google Scholar, 12Kovesdy C.P. Updates in hyperkalemia: outcomes and therapeutic strategies.Rev Endocr Metab Disord. 2017; 18: 41-47Crossref PubMed Scopus (55) Google Scholar This special issue of Kidney International Supplements is based on 2 satellite symposiums held at the 2017 International Society of Nephrology World Congress of Nephrology Meeting. The topics included a discussion of emerging treatment options for managing anemia and hyperkalemia in CKD. The speakers are world-known experts in their respective fields and they provided cutting-edge discussions presenting emerging evidence for changing treatment paradigms. It was our pleasure to organize and serve as moderators for these symposiums and now guest editors for this special supplement. We are grateful for the speakers and their diligent work in creating the content for the symposium and their agreement to provide the content in this supplement. We hope that you find this a valuable resource in understanding the emerging treatment strategies for anemia and hyperkalemia. Publication of this article was supported by AstraZeneca and FibroGen. DWC has received research support from FibroGen, GlaxoSmithKline, Celgene, Eli Lilly, and Janssen; and speaking and consultant honoraria or paid advisory boards from AMAG, Eli Lilly, GlaxoSmithKline, and AstraZeneca. CPK has received speaking and consultant honoraria and advisory fees from Abbott, Abbvie, Amgen, AstraZeneca, Bayer, Fresenius Medical Care, Genzyme, Keryx, and Sanofi-Aventis; research support from Shire; travel support from Abbott, Abbvie, Amgen, Bayer, Keryx, Fresenius Medical Care, and Sanofi-Aventis; and NIH-NIDDK funding. Publication of this article was supported by AstraZeneca and FibroGen. This supplement summarizes the two continuing medical education meetings held during the International Society of Nephrology/World Congress of Nephrology conference. The two educational meetings were supported by an educational grant from FibroGen and AstraZeneca. FibroGen and AstraZeneca had no involvement in the development of the two continuing medical education meetings or this supplement. The Med Ed Group, Inc, the meeting organizers, provided editorial support for this supplement. SynAptiv accredited the two continuing medical education meetings and has reviewed this supplement.