Clinical Efficacy Of Roxadustat In Initial Hemodialysis Patients With Renal Anemia

Objective:To observe and compare the clinical efficacy and safety of roxadustat versus recombinant human erythropoietin(rhEPO)for the treatment of renal anemia in initial hemodialysis patients.Methods:A retrospective analysis was performed on 156 patients undergoing hemodialysis from January 2019 to June 2022 in The Second Hospital of Shandong University.123 patients with initial hemodialysis(dialysis duration ≤3 months)were divided into 63 patients in the observation group(receiving roxadustat)and 60 patients in the control group(receiving rhEPO)according to the treatment plan.In addition,33 patients with maintenance hemodialysis(dialysis duration>3 months)were included,namely the non-initial hemodialysis group.Collected the data of hemoglobin(Hb)in each group before treatment and 1,3 and 6 months after treatment,calculate the Hb qualified rate and effective rate,as well as renal function,iron metabolism,lipid metabolism and other biochemical indexes before treatment and 3 and 6 months after treatment.Observed the adverse reactions of the patients in each groups.Results:1.There were no significant differences in baseline indexes between observation group and control group,and between observation group and non-initial hemodialysis group(P>0.05).2.The level of Hb increased in all 3 groups after 1,3 and 6 months of treatment(P<0.05).The level of Hb in observation group was significantly higher than that of control group after 1 and 6 months of treatment(P<0.05),and Hb qualified rate and effective rate in observation group were higher than those in control group(P<0.05).There were no significant differences in Hb level at each time point,Hb qualified rate and effective rate between observation group and non-initial hemodialysis group(P>0.05).Subgroup analysis suggested that roxasdustat may be more effective in the treatment of patients with high CRP and low ALB.Roxasdustat effectively improved renal anemia of diabetic kidney disease(DKD)patients,similar to the effect of rhEPO.There were significant differences in Hb and Lipoprotein a(LPa)(P<0.05),and there were on significant differences in age,gender,primary disease,total cholesterol(TCH),triglyceride(TG),low density lipoprotein cholesterol(LDL-C),serum iron,ferritin,serum creatinine(Scr),C-reactive protein(CRP),albumin(ALB)and parathyroid hormone(PTH)between qualified and unqualified group(P>0.05).3.The level of serum iron and total iron binding capacity increased significantly in observation group after treatment(P<0.05),the level of total iron capacity increased significantly in non-initial hemodialysis group at 6 months after treatment(P<0.05),there were no significant changes in the above indexes in control group(P>0.05).There were no significant difference in the above indexes among all groups at each time point(P>0.05).4.The level of Scr increased gradually,and the level of eGFR decreased gradually in all 3 groups,but there were no statistical significance(P>0.05).5.The level of LDL-C decreased significantly in observation group after treatment(P<0.05),the level of LDL-C decreased significantly in non-initial hemodialysis group at 6 months after treatment(P<0.05),there was no significant change in LDL-C in control group(P>0.05).The level of LDL-C in observation group was significantly lower than that in control group after treatment(P<0.05)6.The level of CRP decreased significantly in observation group after treatment(P<0.05),the level of CRP decreased significantly in non-initial hemodialysis group at 6 months after treatment(P<0.05),there was no significant change in CRP in control group(P>0.05).There was no statistical significance in CRP among all groups at each time point(P>0.05).7.The level of ALB increased significantly in observation group and non-initial hemodialysis group after treatment(P<0.05),The level of ALB increased significantly in control group at 6 months after treatment(P<0.05).There was no statistical significance in ALB among three groups at each time point(P>0.05).8.There was no statistical significance in PTH among three groups(P>0.05).The level of serum potassium increased significantly in control group after treatment(P<0.05),there was no significant change in serum potassium in observation group and non-initial hemodialysis group(P>0.05).9.There was no statistical significance in the incidence of adverse reactions among three groups(P>0.05),and no serious cardiovascular and cerebrovascular adverse events occurred.Conclusions:Firstly,compared with rhEPO,roxadustat has better clinical efficacy in the treatment of initial hemodialysis patients with renal anemia,which can improve patients’ anemia more quickly and stabilize Hb at the target level.Secondly,roxadustat can improve iron metabolism and lipid metabolism,and do not affect the progression of renal function.Finally,roxadustat is less affected by micro-inflammation and nutritional status and has good safety,which is more beneficial to initial hemodialysis patients.