Chemistry, Analysis, and Biological Aspects of Daprodustat, A New Hypoxia Inducible Factor Prolyl Hydroxylase Inhibitor: A Comprehensive Review

BACKGROUND

The National Health and Nutrition Examination Survey (NHANES) carried out a survey between 2007-10 and found that as compared to the general population, the prevalence of anemia in chronic kidney disease (CKD) patients was twice high. Daprodustat is an investigational novel drug for the treatment of renal anemia.

OBJECTIVE

The objective of this study is to provide a comprehensive review of chemistry, synthesis, pharmacology, pharmacokinetic, and bioanalytical methods for the analysis of Daprodustat.

METHODS

To improve understanding, a review was carried out by creating a database of relevant prior research from electronic sources such as ScienceDirect and PubMed. The methodology is shown in the flowchart of the literature selection process.

RESULTS

The drug was approved in 2020 for therapeutic purposes in Japan. It is a novel drug approved for the treatment of anemia in chronic kidney disease for oral administration. It is intended for adults who have undergone dialysis for a minimum of four months and are experiencing anemia as a result of chronic kidney disease.

CONCLUSION

This review examines therapeutic, pharmacological, and analytical aspects related to the novel drug Daprodustat.

Murine Malaria Model: Ketoconazole Prevented Malaria while Proguanil and Sulfadoxine/Pyrimethamine Protected against Malaria-associated Anemia and Kidney Damage

BACKGROUND

The concern about the global spread of resistant malaria has made the researchers not focus only on the treatment of established infections but relatively more on the prevention of the disease.

OBJECTIVE

This study evaluates the chemopreventive activity of ketoconazole in a murine malarial model.

METHOD

Five out of seven groups of mice were pretreated for five days with proguanil (PRG), sulfadoxine/ pyrimethamine (SP), 10, 20, and 40 mg/kg body weight (b.w) of ketoconazole (KET10, KET20, and KET40), before being infected (on the sixth day) with Plasmodium berghei. Two other groups were infected-not-treated (INT) and not-infected-nor-treated (NINT). At 72 hours postinfection, five out of ten mice in each group were sacrificed to assess parasitemia, chemoprevention, hematologic, hepatic, and renal parameters. The remaining mice were observed for 28 days to determine their mean survival day post-infection (SDPI).

RESULTS

All ketoconazole groups, except KET10, demonstrated 100% chemoprevention and significantly higher mean SDPI (p<0.001) in relation to INT (negative control). There was no significant difference in the mean SDPI observed in KET20 in relation to PRG or NINT (healthy control). A dose-related increase (p<0.01) in the mean plasma urea was observed when ketoconazole groups were compared to one another: KET10 versus KET20 (p<0.01) and KET20 versus KET40 (p<0.01). Sulfadoxine/pyrimethamine demonstrated significantly reduced mean plasma urea (p<0.001) and creatinine (p<0.05) in relation to INT and NINT, respectively. While PRG demonstrated significantly higher mean red blood cell (RBC), hemoglobin (HGB), and hematocrit (HCT) in relation to INT.

CONCLUSION

Ketoconazole possesses prophylactic antimalarial activity with associated dose-related renal impairment. Sulfadoxine/pyrimethamine demonstrated renoprotective potentials, while PRG prevented malaria-associated anemia.

Effect of Maternal Education on Prenatal Adherence of Iron-folic Acid Supplementation in Ethiopia: A Systematic Review and Meta-analysis

BACKGROUND

Iron-folic acid supplementation is a central preventive measure for maternal anemia, so considering the factors leading to or deterring from adherence is important. This review aims to establish if there is a correlation between increasing maternal education and adherence to iron-folic acid supplementation in Ethiopia.

METHODS

An electronic database search was conducted using PubMed, Google Scholar, Cochrane Library and African Journals Online. Joanna Briggs Institute Meta-Analysis of Statistical Assessment and Review Instrument was used for quality appraisal of the included studies. The extracted data were entered into Microsoft™ Excel sheet and exported to R-software version 3.6.1 for analysis. Maternal education on adherence of iron-folic acid supplementation was analyzed and subgroup analyses of difference between regions and time of study period were conducted.

RESULTS

The online search yielded a total of 936 articles, and based on inclusion/exclusion criteria nine were included in this study with a total of 3263 participants. Applying the random effect model, the analysis revealed that the odds of prenatal adherence of iron-folic acid supplementation were 2.89 times higher in mothers with secondary school education and above as compared to those who had not received formal education.

CONCLUSION

This review identified that increased maternal education leads to improved adherence of iron-folic acid supplementation amongst women across Ethiopia. This information may inform efforts of government and non-government organizations to encourage maternal education in order to sustained adherence of iron-folic acid supplementation. Further research is required in this critical area at regional, national, and global levels.

Should We Use Preoperative Epoetin-α in the Mildly Anemic Patient Undergoing Simultaneous Total Knee Arthroplasty?

Simultaneous knee arthroplasty is associated with significant blood loss. To prevent transfusion, three preoperative doses of epoetin-α were offered to mildly anemic simultaneous knee arthroplasty patients. A retrospective review, using ICD-9 codes, identified twenty patients from 2007-2009. Epoetin-α increased hemoglobin levels preoperatively (12.6 to 13.9, p<0.01). Twenty patients who did not receive epoetin-α were matched to study patients. Study patients were transfused less (55% vs 95%, p=0.012) and had similar inpatient length of stay. The average blood loss without transfusion was 4.6g/dL. The mildly anemic patient is at high-risk for packed red cell transfusion during simultaneous knee arthroplasty. Three preoperative doses of epoetin-α in the mildly anemic patient decreased total transfusions; however, it did not affect inpatient length of stay.