Vadadustat is used for anemia of chronic kidney disease in dialysis patients and may cause multiple types of adverse reactions involving the cardiovascular, hepatic, and gastrointestinal systems, requiring focused monitoring.

1. Cardiovascular and Thrombosis-Related Side Effects

1. Thrombotic Vascular Events

Vadadustat may increase the risk of arterial and venous thrombotic events, which can be fatal in severe cases.

These include myocardial infarction, stroke, venous thromboembolism, and vascular access thrombosis.

Patients with cardiovascular or cerebrovascular disease are at higher risk.

A rapid rise in hemoglobin or an excessively high target value may further increase the risk.

The lowest effective dose should be used, avoiding hemoglobin levels above 11 g/dL.

2. Hypertension

Hypertension is one of the most common adverse reactions and may be newly onset or worsened.

Some patients may experience hypertensive crisis, and even hypertensive encephalopathy and seizures.

Uncontrolled hypertension is a contraindication.

Blood pressure should be monitored regularly during treatment, and antihypertensive therapy should be adjusted when necessary.

2. Hepatic and Neurological Side Effects

1. Hepatotoxicity

Vadadustat may cause hepatocellular injury, mostly occurring early in treatment.

It may present as elevated transaminases and bilirubin, usually without symptoms.

Liver function should be monitored monthly before treatment and during the first 6 months of treatment.

If transaminases remain persistently elevated or are accompanied by elevated bilirubin, the drug should be discontinued.

It is not recommended for patients with cirrhosis or active acute liver disease.

2. Seizures

Seizures have been reported in patients with chronic kidney disease receiving vadadustat.

They may present as new-onset seizures, premonitory symptoms, or changes in seizure frequency.

Neurological symptoms should be closely observed after starting the medication.

Headache, irritability, fear, confusion, and similar symptoms should be reported to the doctor promptly.

3. Gastrointestinal, Malignancy, and Other Side Effects

1. Gastrointestinal Erosion

Gastric or esophageal erosion and gastrointestinal bleeding may occur.

High-risk groups include those with a history of gastrointestinal erosion, peptic ulcer, smoking, or alcohol use.

Symptoms include abdominal pain, black stools, vomiting blood, difficulty swallowing, and others.

Seek medical attention immediately if these manifestations occur.

2. Malignancy Risk

Vadadustat may have unfavorable effects on cancer growth.

It is not recommended for patients with active malignancy.

Animal studies have not shown increased carcinogenicity, but clinical data are limited.

3. Other Common Adverse Reactions

Diarrhea is relatively common, and some patients discontinue treatment due to gastrointestinal symptoms.

Headache, nausea, fatigue, abdominal pain, vomiting, dizziness, dyspnea, and others may also occur.

Most adverse reactions can be relieved through symptomatic management or dose adjustment.

4. Medication Monitoring and Patient Education

Hemoglobin, blood pressure, liver function, and iron status should be monitored during treatment.

Patients should understand the warning symptoms of thrombosis, hypertension, seizures, and gastrointestinal bleeding.

Seek medical attention promptly if severe discomfort occurs, and avoid stopping or changing the dose on your own.