Educational Symposium

When Bone Mineral Disease and Anemia Management Collide

November 08, 2019 | 12:45 PM - 01:45 PM

Location: TBD 5, Marriott Marquis

Session Description

The last two decades of research have brought a dramatic increase in our knowledge about the regulation of phosphate metabolism and bone mineral disease alongside increased insight into iron metabolism and the regulation of erythropoiesis. Data from animal studies, observational human cohort studies, and clinical trials have uncovered a previously underappreciated link between these complications of CKD, which seem to involve the function of fibroblast growth factor 23 (FGF-23). Understanding the pathophysiology of calcium, phosphate, and bone metabolism in relation to the pathophysiology of iron metabolism and erythropoiesis can reveal the optimal treatments of these disorders. Such understanding is directly relevant to the practicing nephrologist as our therapeutic armamentarium grows in diversity. The complexity of this subject is compounded by the possible risks associated with certain forms of treatment. This symposium provides a synthesis of emerging data on the pathophysiologic interaction between regulators of mineral metabolism (calcium, phosphate, and iron), bone metabolism, inflammation, and erythropoiesis in patients with advanced CKD. The different effects of endogenous vs exogenous erythropoietin on FGF-23 and iron metabolism are reviewed along with the impacts and risks of different iron supplementation modalities.

Support is provided by an educational grant from Akebia Therapeutics.

Learning Objective(s)

  • Describe the interaction between erythropoietin and FGF-23 and their implication on iron stores, regulation, and utilization
  • Discuss the effect of erythropoietin stimulation vs supplementation on FGF-23
  • Describe the potential risks and benefits of IV vs oral iron supplementation
  • Explain how treatment of hyperphosphatemia may affect anemia management

Learning Pathway(s)

  • Bone and Mineral Metabolism


  • Orlando M. Gutierrez, MD