Vadadustat is an oral hypoxia inducible factor prolyl hydroxylase inhibitor (HIF-PHI) used to treat anemia associated with chronic kidney disease (CKD). The following provides a detailed explanation from three aspects: taboo populations, taboo foods, and restrictive conditions. Special attention should be paid to cardiovascular risks and medication restrictions for special populations.

1. Taboo population

(1) Non CKD anemia patients: contraindicated for the treatment of non renal anemia such as iron deficiency anemia and hemolytic anemia.

(2) Uncontrolled hypertension: contraindicated for patients with systolic blood pressure>160mmHg or diastolic blood pressure>100mmHg.

(3) Acute kidney injury: Use should only be considered after stable kidney function.

(4) Pregnancy period: Animal studies have shown a risk of embryonic mortality, and pregnant women should avoid using it.

(5) Children: The safety and efficacy of patients under 18 years old have not been established.

2. Forbidden foods

(1) High fat diet: Avoiding high-fat meals (>800 calories) during medication can increase drug exposure by 48%.

(2) Grapefruit products: contain CYP3A4 inhibitors, which may increase the blood concentration of vardesistat.

(3) High potassium foods, such as bananas, orange juice, etc., should be restricted in intake to prevent hyperkalemia.

3. Restrictive conditions

(1) Cardiovascular monitoring: Prior to treatment, it is necessary to assess cardiovascular risk, especially in patients with a history of myocardial infarction or heart failure.

(2) Abnormal liver function: Child Pugh C patients need to adjust the dosage to 150mg/day.

(3) Iron metabolism management: Iron deficiency should be corrected before treatment (transferrin saturation ≥ 20%, ferritin ≥ 100ng/mL).

(4) Drug interactions: Avoid combination with potent CYP3A4 inducers such as rifampicin.

(5) Medication time: It is recommended to take it at the same time every day, on an empty stomach or with meals.