Second Amendment to Agreement for the Provision of a Loan Facility, dated February

This SECOND AMENDMENT TO AGREEMENT FOR THE PROVISION OF A LOAN FACILITY (the “Amendment”), dated as of February 3, 2025 (the “Amendment Effective Date”), is made by and between KREOS CAPITAL VII (UK) LIMITED, a company incorporated in England and Wales under registration number 13611522 whose registered office is at 8 Sackville Street, London, WS1 3DG, as a Lender (the “Lender” and "Lender Representative", which expression shall include its permitted successors and permitted assigns), and AKEBIA THERAPEUTICS, INC., a Delaware corporation (the “Borrower” and "Borrower Representative"), and amends that certain AGREEMENT FOR THE PROVISION OF A LOAN FACILITY dated as of January 29, 2024 (as amended by that certain First Amendment to Agreement for the Provision of a Loan Facility, dated as of July 10, 2024, the “Existing Loan Agreement”) by and between the Lender Representative and the Borrower Representative and the other parties thereto from time to time. The Existing Loan Agreement as amended by this Amendment is hereinafter referred to as the “Loan Agreement”. Capitalized terms used in this Amendment without definition shall have the meanings ascribed to such terms in the Loan Agreement.

WHEREAS, the Borrower Representative and the Lender Representative are party to the Existing Loan Agreement which provides for, among other things, (A) a Loan under Tranche C to be made to the Borrower Representative on the terms and conditions contained in the Existing Loan Agreement, including that the Expiry Date of Tranche C was December 31, 2024 (the “Original Expiry Date”) and (B) a Transaction Fee in respect of Tranche C in an amount equal to [**]% of the aggregate committed amount of Tranche C, [**]% of which was paid on the Closing Date and the remaining [**]% of which (such remaining amount, the “Tranche C Funding Fee”) is payable on the earliest to occur of (i) the date Tranche C is funded, (ii) the date that the commitments in respect of Tranche C are terminated or cancelled and (iii) the date on which the availability period of Tranche C terminates;

WHEREAS, the Borrower Representative has requested the Lender Representative to amend the Loan Agreement to provide for an extension of the Expiry Date for Tranche C to February 3, 2025; and

WHEREAS, the Lender Representative has agreed to provide such extension on the terms and subject to the conditions hereof.

NOW THEREFORE, for good and valuable consideration the receipt and sufficiency of which is hereby acknowledged, the Borrower Representative and the Lender Representative hereby agree as follows:

1.Amendments.

b.The Existing Loan Agreement is hereby amended by deleting Clause 6.2 and replacing it with the following:

a.Lender Representative receives fully executed counterparts of this Amendment signed by Borrower Representative;

b.Borrower Representative shall have delivered, or caused to be delivered, in each case, in form and substance reasonably satisfactory to Lender Representative:

i.to Kreos Capital VII Aggregator SCSp, a duly executed Tranche C Warrant (as defined in the Warrant Agreement, dated as of January 29, 2024, by and among the Borrower and Kreos Capital VII Aggregator SCSp); and

ii.to Lender Representative, a duly executed Drawdown Notice for the Tranche C Loan in the principal amount of $10,000,000, as required by the Loan Agreement;

c.Immediately after giving effect to this Amendment, the representations and warranties in Section 4 of this Amendment shall be true and correct in all material respects (without duplication of any materiality qualifiers therein) as of the Amendment Effective Date with the same effect as though made as of such date (except to the extent that such representations and warranties

specifically refer to an earlier date, in which case they are true and correct in all material respects (without duplication of any materiality qualifiers therein) as of such earlier date);

d.Immediately after giving effect to this Amendment, no Default or Event of Default exists; and

e.Borrower Representative shall have paid all fees, costs and expenses required to be paid by it under the Loan Documents as of the Amendment Effective Date (including all fees, charges and disbursements of counsel to Lender Representative in connection with this Amendment) to the extent invoiced on or before [**] prior to the Amendment Effective Date.

3.Ratifications. Borrower Representative (a) ratifies and confirms all provisions of the Loan Documents as amended by this Amendment; (b) ratifies and confirms that all guaranties and liens granted to the Lender Representative under the Loan Documents are not released, reduced, or otherwise adversely affected by this Amendment and continue to guarantee and secure, as applicable, full payment and performance of all present and future obligations under the Loan Documents; and (c) subject to the Perfection Exceptions and any other exceptions, thresholds, limitations and deadlines contained in the other Loan Documents, agrees to perform such acts and duly authorize, execute, acknowledge, deliver, file, and record such additional documents, and certificates as the Lender Representative may request in order to create, perfect, preserve, and protect those guaranties, assurances, and Security Interests.

4.Representations. Borrower Representative hereby represents and warrants to the Lender Representative that as of the date of this Amendment:

a.the Borrower Representative has the corporate capacity, and has taken all corporate action and obtained all corporate consents, necessary for it to execute this Amendment and perform its obligations hereunder;

b.this Amendment will, upon execution and delivery thereof by all parties hereto, constitute the Borrower Representative’s legal, valid and binding obligation enforceable against the Borrower Representative in accordance with its terms, subject to the effects of bankruptcy, insolvency, fraudulent conveyance, reorganization, moratorium and other similar laws relating to or affecting creditors’ rights generally, and general equitable principles (whether considered in a proceeding in equity or at law);

c.the execution and delivery of this Amendment by the Borrower Representative does not violate (i) any applicable material law or other material legal or regulatory requirement or (ii) its organizational documents;

d.all representations and warranties in the Loan Documents are true and correct in all material respects (without duplication of any materiality qualifiers therein) as of the Amendment Effective Date with the same effect as though made as of such date (except to the extent that such representations and warranties specifically refer to an earlier date, in which case they are true and correct in all material respects (without duplication of any materiality qualifiers therein) as of such earlier date); and

5.Continued Effect. Except to the extent amended hereby, all terms, provisions and conditions of the Loan Agreement and the other Loan Documents, and all documents executed in connection therewith, shall continue in full force and effect and shall remain enforceable and binding in accordance with their respective terms. Without limitation of the foregoing or Section 2(e), all unpaid legal fees of Lender Representative in connection with this Amendment and the transactions contemplated hereby shall be paid by the Borrower, to the extent required by and in accordance with the terms of Section 10.3.1 of the Loan Agreement.

6.Post Amendment Effective Date Covenant.

a.On or before the [**] following the Amendment Effective Date (or such later time period as the Lender Representative may agree in its reasonable discretion), the Borrower Representative shall have delivered a supplemental Perfection Certificate to the Lender Representative.

9.RELEASE. BORROWER REPRESENTATIVE AND EACH LOAN PARTY HEREBY ACKNOWLEDGES AND AGREES THAT, AS OF THE DATE HEREOF, SUBJECT TO APPLICABLE LAW, THE OBLIGATIONS UNDER THE LOAN AGREEMENT AND UNDER THE OTHER LOAN DOCUMENTS ARE ABSOLUTE AND UNCONDITIONAL WITHOUT ANY RIGHT OF RESCISSION, SETOFF, COUNTERCLAIM, DEFENSE, OFFSET, CROSS-COMPLAINT, CLAIM OR DEMAND OF ANY KIND OR NATURE WHATSOEVER THAT CAN BE ASSERTED TO REDUCE OR ELIMINATE ALL OR ANY PART OF ITS LIABILITY TO REPAY SUCH OBLIGATIONS OR TO SEEK AFFIRMATIVE RELIEF OR DAMAGES OF ANY KIND OR NATURE FROM LENDER REPRESENTATIVE. BORROWER REPRESENTATIVE AND EACH LOAN PARTY HEREBY VOLUNTARILY AND KNOWINGLY RELEASES AND FOREVER DISCHARGES LENDER REPRESENTATIVE, AND ITS PREDECESSORS, AGENTS, EMPLOYEES, SUCCESSORS, AND ASSIGNS (COLLECTIVELY, THE “RELEASED PARTIES”), FROM ALL POSSIBLE CLAIMS, DEMANDS, ACTIONS, CAUSES OF ACTION, DAMAGES, COSTS, EXPENSES, AND LIABILITIES WHATSOEVER ARISING FROM OR UNDER THE LOAN DOCUMENTS, AND THE TRANSACTION EVIDENCED THEREBY, [**], FIXED, CONTINGENT, OR CONDITIONAL, AT LAW OR IN EQUITY, ORIGINATING IN WHOLE OR IN PART ON OR PRIOR TO THE DATE HEREOF WHICH BORROWER REPRESENTATIVE AND/OR ANY SUBSIDIARY GUARANTOR MAY NOW OR HEREAFTER HAVE AGAINST THE RELEASED PARTIES, IF ANY, AND IRRESPECTIVE OF WHETHER ANY SUCH CLAIMS ARISE OUT OF CONTRACT, TORT, VIOLATION OF LAW OR REGULATIONS, OR OTHERWISE, INCLUDING, WITHOUT LIMITATION, ANY CONTRACTING FOR, CHARGING, TAKING, RESERVING, COLLECTING, OR RECEIVING INTEREST IN EXCESS OF THE HIGHEST LAWFUL RATE APPLICABLE.

10.Incorporation by Reference. Clauses 2, 15.1, 15.3, 15.15, 15.17, 15.18, 15.21, 15.22, 15.23, 15.24, 15.25 and 15.26 of the Loan Agreement are hereby incorporated by reference mutatis mutandis.

11.Governing Law. THIS AMENDMENT SHALL BE CONSTRUED IN ACCORDANCE WITH AND GOVERNED BY THE LAWS OF THE STATE OF NEW YORK.