| BackgroundPatients on new peritoneal dialysis(PD)represent a vulnerable group,suffering from the fastest rate of decline in residual renal function(RRF)and the highest risk of readmission and death within the first year after starting dialysis.It has been reported that renal anemia is prevalent in PD patients and is an independent risk factor for the development of cardiovascular events.Several studies have shown that early correction of anemia in patients is important to delay the decline of RRF,reduce the incidence of cardiovascular events and improve prognosis.Erythropoiesis-stimulating agents(ESAs)are commonly used to improve hemoglobin levels,but they have limitations due to their susceptibility to inflammatory status and impaired iron absorption and utilization.Roxadustat is a novel oral hypoxia-inducible factor prolyl hydroxylase inhibitor(HIF-PHI)that stabilizes hypoxia-inducible factors(HIFs)by simulating intracellular hypoxia and improves iron metabolism.Currently,the short-term efficacy of this drug in improving renal anemia has been extensively validated by national and international studies,but data on its long-term therapeutic effects(1 year)and impact on RRF are limited.Therefore,the present study aimed to evaluate the long-term maintenance effect of Roxadustat for renal anemia and its impact on RRF in new PD patients by retrospective analysis,and to offer new clinical ideas for enhancing anemia management and improving prognosis in patients with PD initiationObjectiveTo observe the efficacy and safety of oral Roxadustat for the treatment of renal anemia in new peritoneal dialysis patients and to assess its effect on residual renal function.MethodsData of end-stage renal disease combined with renal anemia patients who started PD at the First Affiliated Hospital of Zhengzhou University in China from September 1,2019 to November 30,2020 were enrolled in this study.Patients were divided into two groups according to the anti-renal anemia drug they were taking at the start of PD:those treated with Roxadustat(study group)and those treated with rhuEPO(control group).All patients were followed up for at least 12 months.The effects of Roxadustat on renal anemia and RRF were evaluated and the incidence of adverse effects and cardiovascular adverse events in the two groups were recorded during the study period.The possible factors effecting the decline in RRF were analyzed in a stratified way.Results1.A total of 221 new PD patients were included in this study,and 82 patients were finally enrolled,including 37 patients in the study group and 45 patients in the control group.There were no statistically significant differences between the two groups in terms of general clinical data and laboratory indices,dialysis adequacy,and RRF levels at baseline(all P>0.05).2.The mean Hb levels in both groups were significantly higher than the baseline values at each time point of treatment,and the average rate of increase was(1.48±1.40)g/L/month in the study group and(1.07±1.73)g/L/month in the control group,with no statistically significant difference between the two groups(P>0.05).After 12 months of treatment,the mean Hb levels of patients in the study group were significantly higher than those in the control group(112.24 ± 15.34 vs.105.40±14.95,P<0.05)and increased by(29.66 ± 19.88)g/L and(20.10 ± 22.15)g/L,respectively,from baseline values.3.Roxadustat improved renal anemia independent of inflammatory status and higher mean Hb levels in the study group than in the control group was observed in the high baseline CRP subgroup(P<0.05)4.There was a trend of gradual decrease in the mean RRF level in both groups,and the rate of decline was[-0.12 mL/(min/1.73 m2/month)]in the study group and[-0.19mL/(min/1.73 m2/month)]in the control group(P<0.01).After 12 months of treatment,the mean RRF level was higher in the study group than in the control group(2.93 ± 1.91 vs.1.82 ± 1.49,P<0.01).5.A subgroup analysis of the multifactorial effect on RRF levels showed that patients in the high baseline CRP subgroup had lower RRF levels after 12 months of treatment in the control group than in the low CRP subgroup(P<0.05),whereas there was no significant difference within the study group(P>0.05).6.After 12 months of treatment,patients in the study group had higher total iron binding and 24h urine output levels and lower C-reactive protein,total cholesterol,and low-density lipoprotein levels than the control group,and all of the values were statistically significant(all P>0.05).7.During the treatment period,no serious adverse reactions occurred in both groups,and the incidence of hypertension in the study group was lower than in the control group(P<0.05).ConclusionIn patients new to PD,Roxadustat can effectively improve renal anemia with a good safety profile,and its long-term maintenance effect is better than rhuEPO;compared with rhuEPO,Roxadustat can delay the decline of residual renal function and may have a good protective effect on residual renal function levels and the mechanism may be related to the control of microinflammation. |
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