- Hill NR et al PLOS ONE, DOI:10.1371/journal.pone.0158765
- Babitt JL, Lin HY. Mechanisms of anemia in CKD. J Am Soc Nephrol. 2012;23(10):1631-4.
- Hill NR et al PLOS ONE, DOI:10.1371/journal.pone.0158765
- https://www.kidney.org/atoz/content/what_anemia_ckd, last accessed on 12 September 2019
- https://www.niddk.nih.gov/health-information/kidney-disease/mineral-bone-disorder
- US-DOPPS Practice Monitor, October 2013; http://www.dopps.org/DPM/.
- Tonelli M, et al. Oral Phosphate Binders in Patients with Kidney Failure; NEJM 2010;362:1312–1324.
- Wang S et al. Serum phosphorus levels and pill burden are inversely associated with adherence in patients on hemodialysis; Nephrol Dial Transplant 2014;29(11):2092-9.
- Chiu YW, et al. Pill Burden, Adherence, Hyperphosphatemia, and Quality of Life in Maintenance Dialysis Patients; Clin J Am Soc Nephrol 2009;4(6):1089–1096.
- Sprague SM et al. Exp Rev Endocrinol Metab. 2017;12(5):289–301.
- Levin A et al. Kidney Int. 2007;71:31–8.
- Cunningham J et al. Clin J Am Soc Nephrol. 2011;6:913–21.
- Rodriguez M et al. Am J Renal Physiol. 2005;288:F253–64.
- Einhorn LM et al Arch Intern Med. 2009;169(12):1156–1162
- Ponikowski et al Eur Heart J 2016 (37, 2129–2200)
- Rayner, H. C., Larkina, M., Wang, M., Graham-Brown, M., van der Veer, S. N., Ecder, T., … Pisoni, R. L. (2017). International Comparisons of Prevalence, Awareness, and Treatment of Pruritus in People on Hemodialysis. Clinical journal of the American Society of Nephrology, 12(12), 2000–2007. doi:10.2215/CJN.03280317
- Pisoni RL, et al. Pruritus in hemodialysis patients: international results from the Dialysis Outcomes and Practice Patterns Study (DOPPS). Nephrol Dial Transplant. 2006; 21:3495-3505.
- Ramakrishnan et al. Clinical characteristics and outcomes of end-stage renal disease patients with self-reported pruritus symptoms. International Journal of Nephrology and Renovascular Disease. 2014; 7: 1-12.
- Mathur V. et al. A longitudinal study of uremic pruritus in hemodialysis patients. Clin J Am Soc Nephrol. 2010; 5(8):1410-1419.
- Narita I. et al. Etiology and prognostic significance of severe uremic pruritus in chronic hemodialysis patients. Kidney International (2006)
- Tuttle K.R. et all (2014) Diabetic Kidney Disease: A Report From an ADA Consensus Conference.
- Diabetes Care 2014;37:2864–2883 | DOI: 10.2337/dc14-1296
NEPHROLOGY
WE FOCUS ON A BROAD AND INNOVATIVE NEPHROLOGY PORTFOLIO
Chronic kidney disease (CKD) is relatively common among adults, with prevalence of up to 13%1 and rising as the population ages. CSL Vifor strives to improve lives of people suffering from kidney diseases, through our broad, innovative nephrology portfolio and individualized solutions.
We partner with specialists to improve lives of patients with high unmet medical needs across all stages of kidney disease, from early stage to post transplantation. Through our innovative nephrology portfolio and individualized solutions we aim to preserve renal function, manage complications and improve quality of life.
MINERAL AND BONE DISEASE MANAGEMENT
If the kidney is damaged, it can pose significant health risks, including mineral and bone disorder. Hormones and minerals play an essential role for bones and cardiovascular health.5
Hyperphosphatemia
Phosphorus is a mineral which plays an essential role in bone metabolism and cellular functions. An abnormal elevation of phosphorus levels – Hyperphosphatemia – in the blood, is a common and serious condition in CKD patients on dialysis, because the kidneys cannot remove extra phosphorus.
Most patients are treated with a phosphate binder, however up to 50% of patients – depending on the region – are unable to achieve and maintain their target serum phosphorus levels.6 In some patients, non-compliance due to the high pill burden and poor tolerability appear to be key factors behind this.7,8 On average, dialysis patients take approximately 19 pills per day, with phosphate binders comprising around 50% of this daily pill burden9.
SECONDARY HYPERPARATHYROIDISM (SHPT)
SHPT is characterised by increased secretion of parathyroid hormone (PTH) due to disrupted mineral and vitamin D homeostasis in chronic kidney disease (CKD) patients.
It affects 40–82% of patients with stage 3 or 4 CKD.10-13
The loss of mineral homeostasis leads to an enlargement of the parathyroid glands, as well as bone and vascular complications, which are linked with increased morbidity (the rate of disease in a person or population) and mortality.12,13
Hyperkalaemia
Hyperkalaemia is defined as abnormally elevated levels of potassium in the blood, a serious condition in cardio-renal patients that can be responsible for cardiac arrhythmias leading to cardiac arrest and death, with a resulting mortality rate of up to 30%.
Severe hyperkalaemia is an independent predictor of mortality and hospitalisations. Recurrent hyperkalaemia frequently occurs in patients with chronic kidney disease suffering from hypertension or diabetes, with or without heart failure.14 It is often triggered by treatment with renin-angiotensin-aldosterone system inhibitors (RAASi), the cornerstone therapy for a number of conditions in cardio-renal patients such as hypertension or heart failure.15
CONDITIONS ASSOCIATED WITH KIDNEY IMPAIRMENT
CKD-associated pruritus (CKD-AP) Chronic kidney disease-associated pruritus (CKD-aP) is an intractable systemic itch condition that occurs with high frequency and intensity in both dialysis and non-dialysis CKD patients.16
About 60-70% of CKD patients on dialysis report pruritus; of these, 30-40% experience moderate to severe pruritus.17,18 Nearly 60% of CKD-aP patients experience symptoms almost every day for months or years, even when using antihistamines and corticosteroids. Chronic pruritus directly decreases quality of life and contributes to symptoms that impair quality of life19; the disease is also associated with depression.19 CKD-aP is an independent predictor of mortality related to increased risk of inflammation and infections in haemodialysis patients.20