Akebia Therapeutics

Management reacquired full U.S. dialysis channel rights to Vafseo via a termination and settlement with CSL Vifor, trading ongoing royalties and true‑ups for strategic control. It raised equity in 2025, employed an ATM in 2026, and layered a term loan facility; aggregate dilution is meaningful.

On offense, Akebia added mid‑stage optionality via praliciguat (licensed) and a tissue‑targeted complement inhibitor, ebribafusp (acquired from Q32 Bio), with modest upfronts but meaningful downstream milestones.

These moves are strategically coherent for nephrology focus, yet financing mix and future returns remain to be proven, warranting a mid‑pack score.