Vadadustat is an oral medication used to treat anemia in chronic kidney disease. Its usage and dosage should be adjusted according to hemoglobin levels, body weight, and liver function. Special attention should be paid to cardiovascular risks and metabolic differences when using it in special populations. The following provides detailed explanations from three aspects: standard usage, dosage adjustment, and special populations.

1. Standard usage and dosage

(1) Initial dose: Most patients recommend an initial dose of 300mg once daily, adjusted based on hemoglobin response.

(2) Target range: Maintain hemoglobin levels between 10-12 g/dL and avoid exceeding 13 g/dL.

(3) Administration method: Take the whole tablet orally, on an empty stomach or with meals, avoid taking it with high-fat meals.

2. Dose adjustment plan

(1) Rapid increase in hemoglobin (>1g/dL/2 weeks): a reduction of 25% -50% is required.

(2) Liver dysfunction: Children Pugh grade C patients should reduce their dosage to 150mg/day.

(3) Weight<60kg: Consider starting with a lower dose (such as 200mg).

3. Medication for special populations

(1) Liver function impairment: Child Pugh A/B grade does not require adjustment, while C grade requires a 50% reduction.

(2) Renal dysfunction: Dialysis patients need to receive medication after dialysis without the need for additional dose adjustments.

(3) Elderly: Patients aged 65 and above need to be closely monitored for cardiovascular events and changes in blood pressure.

(4) Pregnant women: Prohibited, animal studies show embryonic toxicity risk.

(5) Breastfeeding period: It is recommended to stop taking medication or breastfeeding. It is unknown whether the medication has entered the breast.

(6) Children: The safety of patients under 18 years old has not been established and is not recommended for use.