Most dialysis patients have anemia, which is characterized by low hemoglobin. Anemia can cause a lot of problems like fatigue, weakness, shortness of breath, and so on. So it's very important that dialysis patients correct their anemia.
Traditionally, most drugs for anemia have been administered subcutaneously using an injection in the form of a pre-filled syringe. This method has the downside of requiring an extra needle stick for the patient. While most patients already endure two significant needle sticks during their thrice-weekly dialysis sessions, an additional prick is never welcomed. Unfortunately, until now, there were no alternatives; it always had to be an injection.
Another issue with these injections is the strict temperature requirement—they must be kept between 2 and 7 degrees Celsius. The journey from the manufacturing site to the point of administration is fraught with challenges. Once produced, the injection travels to various distribution centers and then passes through multiple hands. A delivery agent eventually brings it to the hospital, dialysis center, or patient's home. Throughout this entire process, maintaining the 2 to 7 degrees Celsius range is crucial. If even one person in this chain fails to keep the injection within this temperature range, its contents become ineffective, rendering it no better than injecting plain water.
Thankfully, recently, a new class of drugs known as HIF-PHIs has emerged. These HIF-PHIs offer multiple advantages. Firstly, they come in oral tablet form, eliminating the need for additional injections and pricks. Secondly, at least some of them can be stored at room temperature, bypassing the stringent 2 to 7 degrees Celsius requirement. This effectively addresses both issues associated with injections.
In countries like India, where hot weather prevails for most of the year, the temperature issue becomes one of the biggest challenges in ensuring the effectiveness of these injections. Unfortunately, many healthcare workers are unaware of the critical importance of maintaining this temperature range. Often, they exhibit a callous attitude and fail to take the necessary precautions. The real trouble is that patients cannot discern whether the proper temperature has been maintained. The person delivering the injection only needs to ensure it feels cold, but no one knows what happened during its journey. If at any point the injection was not kept at the correct temperature, it loses all its effectiveness. Even if stored correctly afterward, it does not regain its potency. This is a significant problem in the current method of transporting injections.
Given these challenges, I firmly believe that HIF-PHIs should be rapidly introduced in countries like ours. The fact that they come as oral tablets rather than injections is a significant advantage. Moreover, the less stringent storage requirements mean that their effectiveness is more likely to be preserved. While I understand the cautious approach due to their novelty, it is imperative that we take proactive steps to encourage the adoption of HIF-PHIs, especially for dialysis patients and those with chronic kidney disease.
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