Novel therapies for CKD
Currently, there are many novel agents that are being investigated to slow progression of CKD. Most studies have focused on diabetic kidney disease; however, there are small clinical trials suggesting benefit of some agents in nondiabetic kidney disease. Antifibrotic agents such as tranilast have been shown to reduce the decline in kidney function and proteinuria; however, there has been concern for adverse hepatic and renal effects when used at higher doses in cardiology trials. Agents targeting glycosaminoglycan metabolism such as sulodexide, inhibitors of advanced glycation end products, and anti-inflammatory agents such as pentoxifylline have all demonstrated short-term effects in proteinuria reduction. How these agents will perform in large-scale randomized clinical trials remains to be seen. As of now, there are no novel approved therapies for the treatment of CKD.
Roxadustat is an oral inhibitor of hypoxia-inducible factor (HIF) prolyl hydroxylase that stimulates erythropoiesis and regulates iron metabolism. It shows promise as an alternative to epoetin alfa as a therapy for anemia in patients with CKD. It is currently in phase III clinical trials.
Veverimer is a nonabsorbed polymer which selectively binds and removes hydrochloric acid from the gastrointestinal lumen and is being investigated for the treatment of metabolic acidosis in patients with CKD. It has been shown to significantly increase serum bicarbonate concentration, with minimal adverse effects. The Food and Drug Administration is currently reviewing an application for approval.
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