Kidney involvement and anemia in COVID-19 infection

Table 2 Use of erythropoiesis-stimulating agents and hypoxia-inducible factor prolyl hydroxylase inhibitor in patients with chronic kidney disease

Agent	Initiation threshold	Hb target	Dosing	Maximum recommended doses	Monitoring
ESAs
	ND-CKD: Carefully weigh risks and benefits. Individualized initiation threshold; for most people, Hb 80-10.0 g/dL; DD-CKD: Hb concentration ≤ 9.0-10.0 g/dL	Hb level < 11.5 g/dL	ND-CKD: 4000 or 10 000 U weekly or every 2 wk; DD-CKD: 50-100 U/kg, 3 times weekly	-	Following initiation: Every 2-4 wk. During maintenance phase: At least once every 3 mo
			ND-CKD: 40-100 µg every 2-4 wk; DD-CKD: 0.45 μg/kg weekly or 0.75 μg/kg every 2 wk	-
Methoxy polyethylene glycol-epoetin beta			ND-CKD: 50-120 µg every 2 wk or 120-200 µg every month; DD-CKD: 0.6 µg/kg every 2 wk	-
HIF-PHIs
Advantages and benefits (vs ESAs): Reduction in hepcidin; improved iron bioavailability and utilization; decreased serum cholesterol levels; oral route of administration. HIF-PHIs are more likely to improve anemia in patients with chronic inflammation and ESAs hyporesponsiveness, while reducing the need for intravenous iron supplementation
Limitations and cautions (vs ESAs): Higher incidence of cancer events and related deaths (daprodustat); higher risk of MACEs (vadadustat)
Roxadustat (China, Chile, Egypt, EU, Iceland, Japan, Kuwait, Lichtenstein, Mexico, Norway, Russia, Saudi Arabia, South Africa, South, Korea, Turkey, United Arab Emirates, UK)	ND-CKD: Carefully weigh risks and benefits. Individualized initiation threshold; for most people, Hb 80-10.0 g/dL, DD-CKD: Hb concentration ≤ 9.0-10.0 g/dL	Hb level < 11.5 g/dL	70 mg for body weight < 100 kg, 100 mg for body weight ≥ 100 kg, 3 times weekly (ESA-naïve); 70-200 mg 3 times per week (switch from ESA) (EU). 50 mg 3 times per week (ESA-naïve), 70-100 mg 3 times per week (switch from ESA) (Japan)	ND-CKD: 3 mg/kg or 300 mg, thrice a week (EU); DD-CKD: 3 mg/kg or 400 mg, thrice a week (EU)	2-4 wk after initiation; every 4 wk during therapy
Vadadustat only DD-CKD: Australia, Europe (EU), Korea, Taiwan, and USA ND-CKD and DD-CKD: Japan			300 mg daily	600 mg/d (EU)
Daprodustat (Japan)			ND-CKD: 2-4 mg daily (ESA- naïve), 4 mg daily (switch from ESA). DD-CKD 4 mg daily	24 mg/d
Enarodustat (China, Japan, South Korea)			ND-CKD: 2 mg daily. DD-CKD: 4 mg daily. PD-CKD: 2 mg daily	8 mg/d (Japan)
Molidustat (Japan)			ND-CKD: 25 mg daily (ESA- naïve), 25-50 mg daily (switch from ESA). DD-CKD: 75 mg daily	200 mg/d
Desidustat (India)			100 mg 3 times per week (ESA- naïve), 100-150 mg 3 times per week (switch from ESA)	150 mg three times weekly

CKD: Chronic kidney disease; DD-CKD: Dialysis-dependent chronic kidney disease; ESA: Erythropoiesis-stimulating agent; Hb: Hemoglobin; HIF-PHI: Hypoxia-inducible factor prolyl hydroxylase inhibitor; MACEs: Major adverse cardiovascular events; ND-CKD: Non-dialysis-dependent chronic kidney disease; PD-CKD: Peritoneal dialysis chronic kidney disease.