Hypoxia-inducible factor prolyl hydroxylase inhibitor as a new therapeutic option for treating anemia in feline chronic kidney disease.

Anemia is a frequent complication in cats with chronic kidney disease (CKD), mainly due to decreased erythropoietin (EPO) production resulting from a loss of renal erythropoietin-producing (REP) cells. Anemia affects both survival and quality of life by inducing clinical signs such as lethargy and anorexia. Early detection of anemia by monitoring hematocrit/packed cell volume (Htc/PCV) trends is essential to initiate treatment before progressive renal damage limits therapeutic effectiveness. Molidustat, a hypoxia-inducible factor prolyl hydroxylase inhibitor (HIF-PHI), is a novel oral drug stimulating endogenous erythropoietin synthesis. However, treatment has to be started when REP cells are still functional, with PCV target ranges between 30-40%. Regular monitoring following the International Renal Interest Society (IRIS) guidelines is essential to keep PCV within the target range and to determine when treatment should be started, stopped, or restarted. Moreover, monitoring the iron status is important since both functional and absolute iron deficiency might be seen in cats with CKD and can impair response to treatment.