Akebia Therapeutics, Inc.

What they do

Akebia markets Vafseo (vadadustat), an oral HIF-based treatment for anemia due to chronic kidney disease in adult dialysis patients, approved by the FDA in March 2024 and launched in January 2025. It also markets Auryxia (ferric citrate) in the U.S. for serum phosphorus control in dialysis-dependent CKD and iron deficiency anemia in non-dialysis-dependent CKD. Revenue funds mid-stage rare kidney disease programs (praliciguat, ebribafusp) and early-stage HIF assets (AKB-9090, AKB-10108). Vafseo is approved in 37 countries and marketed outside the U.S. by partners.

Revenue drivers

• Vafseo (vadadustat) — U.S. net product revenue from the oral HIF treatment for anemia in dialysis patients; Q2 2026 revenue was $21.3 million with more than 10,500 patients on therapy, and the company cites an approximately $1 billion U.S. dialysis anemia market opportunity based on current ESA pricing.
• Auryxia (ferric citrate) — U.S. product revenue for serum phosphorus control in DD-CKD and iron deficiency anemia in NDD-CKD; has historically been a meaningful revenue contributor but reached loss of exclusivity in March 2025 and now faces generic competition.
• Partner royalties and ex-U.S. ferric citrate — Ferric citrate and Vafseo are marketed in certain countries outside the U.S. by partners under license and collaboration agreements, generating partner-related revenue.
• Pipeline programs (pre-revenue) — Praliciguat (Phase 2 in FSGS), ebribafusp (Phase 2 basket trial in IgAN, LN, C3G, initial data expected 2027) and early-stage AKB-9090 and AKB-10108 are not currently revenue-generating.

Recent performance

Q2 2026 total revenue was $49.1 million, down from $57.6 million in Q4 2025 and $58.8 million in Q3 2025. Vafseo net product revenue grew to $21.3 million in Q2 2026, a 34% increase over Q1 2026, with more than 10,500 active patients (up 41% from the end of Q1 2026) and approximately 1,200 prescribers (up about 17%). Full-year 2025 revenue was $236.2 million with a net loss of $5.3 million and operating cash flow of $68.0 million. At June 30, 2026, cash and equivalents were $155.5 million, total assets $349.7 million, total liabilities $324.6 million and shareholder equity $25.0 million.

Strategy

Akebia is driving Vafseo adoption with dialysis organizations that cover nearly 100% of U.S. dialysis patients, with approximately 290,000 patients currently having prescribing access. The company is advancing a rare kidney disease pipeline: praliciguat in a Phase 2 FSGS trial (first patient dosed December 2025), ebribafusp in a Phase 2 open-label basket trial of up to 30 patients in IgA nephropathy, lupus nephritis and C3 glomerulopathy, and early-stage AKB-9090 (Phase 1 dosed April 2026 for cardiac surgery-related acute kidney injury) and preclinical AKB-10108 for retinopathy of prematurity. It acquired substantially all Q32 Bio assets in November 2025 to obtain ebribafusp. The VOICE trial interim analysis showed a statistically significant safety benefit for Vafseo versus ESAs, which management frames as supporting a standard-of-care goal. Net product revenue is intended to fund the pipeline.

Risks

• Auryxia generic erosion — Auryxia reached loss of exclusivity in March 2025, and after Teva received approval for a generic version on March 11, 2026 that entered the market, additional generic competition expected in 2026 would adversely impact revenue.
• Vafseo launch execution — Vafseo revenue depends on dialysis organizations operationalizing protocols and prescribers writing prescriptions; Q2 2026 net product revenue of $21.3 million remains well below the roughly $1 billion U.S. dialysis anemia market.
• Pipeline clinical and regulatory risk — Praliciguat, ebribafusp, AKB-9090 and AKB-10108 are in Phase 1 or Phase 2, with ebribafusp initial data not expected until 2027, so failure or delay would leave the company dependent on marketed products.
• Thin equity and capital needs — At June 30, 2026 shareholder equity was $25.0 million against $324.6 million of total liabilities, and the company has a history of losses, so it may need additional capital.

Outlook

Management points to continued sequential Vafseo growth, the goal of making Vafseo standard of care for anemia in dialysis patients following the positive VOICE interim analysis, and expanding prescriber adoption. It expects initial ebribafusp Phase 2 basket trial data in 2027 and continues enrollment in the Phase 2 praliciguat FSGS trial. Akebia also expects additional generic competition for Auryxia in 2026.