Akebia Therapeutics' Vafseo: A Case Study in Operational Execution and Scalable Patient Access Expansion

Akebia Therapeutics' Vafseo, an oral hypoxia-inducible factor prolyl hydroxylase inhibitor (HIF-PH inhibitor), has emerged as a transformative therapy for anemia in chronic kidney disease (CKD) patients on dialysis. While the drug's clinical value is well-established, the company's recent operational execution and patient access expansion have positioned Vafseo as a high-growth asset. By Q2 2025, Vafseo's net product revenue surged to $13.3 million, with prescription demand rising 55% quarter-over-quarter, underscoring the effectiveness of Akebia's strategic initiatives, according to a Akebia Therapeutics report. This momentum is driven by a dual focus on expanding prescriber networks and operationalizing partnerships with dialysis providers, creating a scalable foundation for long-term growth.

Operational Execution: Building a Prescriber and Provider Ecosystem

Akebia's operational strategy centers on removing barriers to adoption for both physicians and dialysis organizations. By September 2025, the company had secured streamlined protocols for Vafseo prescribing with two major dialysis providers-Dialysis Clinics, Inc. (DCI) and Innovative Renal Care (IRC), the fourth and fifth largest U.S. dialysis organizations, according to the Akebia Therapeutics report. These agreements standardize workflows, reducing administrative friction for clinicians and ensuring consistent patient access.

The partnership with DaVita, the nation's largest dialysis provider, represents a pivotal milestone. A 100+ clinic pilot program, launched in 2025, tested the efficiency of Vafseo integration into DaVita's operations. Early results were promising, prompting plans to roll out the drug to all DaVita clinics-a move expected to bring Vafseo to over 200,000 patients, according to the Akebia Therapeutics report. Nicholas Grund, Akebia's Chief Commercial Officer, emphasized that these operational improvements have directly boosted patient adherence, with a notable increase in patients receiving first refills, as noted in a Seeking Alpha article.

Scalable Patient Access: From 40,000 to 200,000+ by 2025

Akebia's patient access expansion has been nothing short of exponential. By the end of Q3 2025, the number of patients with access to Vafseo had surged from 40,000 in the first half of the year to nearly 70,000, with over 25,000 new patients added in the quarter alone, according to the Seeking Alpha article. Management projects this figure to reach 280,000 by early 2026-a 7x increase from the start of 2025, as noted in the Seeking Alpha article.

This growth is underpinned by Akebia's ability to align incentives across stakeholders. For dialysis providers, Vafseo's oral formulation reduces the need for frequent intravenous iron infusions, lowering operational costs. For patients, the therapy offers greater convenience and fewer side effects compared to erythropoiesis-stimulating agents (ESAs). These value propositions have accelerated uptake, particularly as Akebia invests in education and reimbursement support to address prior hesitancy.

The Investment Case: Operational Rigor as a Growth Multiplier

Akebia's success with Vafseo demonstrates how operational execution can amplify the value of a therapeutic innovation. By focusing on scalable access-through partnerships, process optimization, and provider education-the company is transforming Vafseo from a niche product into a standard-of-care therapy. With DaVita's full rollout and continued expansion into smaller dialysis networks, Akebia is well-positioned to capture a significant share of the $3 billion anemia treatment market, according to the Akebia Therapeutics report.

For investors, the key takeaway is clear: Akebia's ability to execute on operational and access initiatives is not just driving near-term revenue growth but also laying the groundwork for durable market leadership. As the company moves closer to its 2026 targets, the scalability of its approach will likely attract broader institutional interest.