Precision Medicine in Erythropoietin Deficiency and Treatment Resistance: A Novel Approach to Management of Anaemia in Chronic Kidney Disease

The study of anaemia is a well-developed discipline where the concepts of precision
medicine have, in part, been researched extensively. This review discusses the treatment of ery
thropoietin (EPO) deficiency anaemia and resistance in cases of chronic kidney disease (CKD).
Traditionally, erythropoietin-stimulating agents (ESAs) and iron supplementation have been used
to manage anaemia in cases of CKD. However, these treatments pose potential risks, including
cardiovascular and thromboembolic events. Newer treatments have emerged to address these risks,
such as slow-release and low-dosage intravenous iron, oral iron supplementation, and erythropoietin
iron combination therapy. Another novel approach is the use of hypoxia-inducible factor prolyl
hydroxylase inhibitors (HIF-PHIs). This review highlights the need for precision medicine targeting
the genetic components of EPO deficiency anaemia in CKD and discusses individual variability in
genes such as the erythropoietin gene (EPO), the interleukin-gene (IL-), and the hypoxia-inducible
factor gene (HIF). Pharmacogenetic testing aims to provide targeted therapies and interventions
that are tailored to the specific characteristics of an individual, thus optimising treatment outcomes and minimising resistance and adverse effects. This article concludes by suggesting that receptor
modification has the potential to revolutionise the treatment outcomes of patients with erythropoietin
deficiency anaemia through the integration of the mentioned approach.