Vadadustat

How it works

It inhibits prolyl hydroxylase enzymes, stabilising hypoxia-inducible factor to promote endogenous erythropoietin production and enhance iron mobilisation, thereby raising haemoglobin.

Prescribing in practice

• Avoid raising haemoglobin excessively or too rapidly, as higher levels are associated with thromboembolic and cardiovascular risk; hepatotoxicity has also been reported.
• Separate dosing from phosphate binders and other cation-containing products that can impair absorption.
• Assess and manage iron status before and during treatment, and review potential drug interactions as described in the SPC.

Monitoring

Monitor haemoglobin regularly with liver function and iron indices, adjusting therapy to maintain the target haemoglobin range.

Counselling the patient

• Take this tablet separately from phosphate binders and indigestion remedies.
• Report chest pain, breathlessness or leg swelling, and attend for your blood tests.

Evidence & guidelines

Vadadustat for anaemia of chronic kidney disease has been evaluated against erythropoiesis-stimulating agents in phase 3 randomised controlled trials.