| BackgroundRenal anemia and left ventricular hypertrophy(LVH)are the main complications of chronic kidney disease(CKD)and are common among dialysis patients.Because it has a high prevalence of mortality,left ventricular hypertrophy poses a serious threat to the life of patients with renal insufficiency.The aim of this study was to compare the efficacies of the hypoxia-inducible factor prolyl hydroxylase inhibitors(HIF-PHIs)roxadustat and erythropoietin in reversing ventricular remodeling in dialysis patients with renal anemia.MethodsThis was a retrospective cohort study that was designed to compare the effects of Roxadustat and recombinant human erythropoietin(rh EPO)on the changes in common indices of cardiac structure and function,including certain clinical and biochemical parameters and blood pressure,in dialysis patients.A total of 204 participants underwent baseline examinations,including echocardiograms and laboratory tests,before being administered either treatment for at least 24 weeks from January2018 to October 2021,after which follow-up examinations were conducted at least twice every 6months during the study period.ResultsEach group included 68 patients,with a total of 136 patients.Compared with baseline,the LVMI of patients treated with roxadustat decreased significantly from 133.99(122.47,156.14)g/m~2to 124.43(105.94,148.72)g/m~2(P<0.001),and the LVMI after rh EPO treatment decreased from135.39±31.89 g/m~2to 129.21±28.08 g/m~2(P=0.005),but there was no significant difference inΔLVMI between the two groups.In the roxadustat group,LVEDd,LVPWT,SBP,and DBP all decreased significantly.However,rh EPO had no significant effect on LVEDd, LVPWT,IVST and LVEF,nor did it significantly decrease blood pressure.There was no significant difference in the changes of cardiac remodeling indexes including LVMI,LVEDd,IVST,LVPWT and LVEF between the two groups.TheΔSBP in the roxadustat group was significantly improved compared with rh EPO,but there was no significant difference in theΔDBP between the two groups.In patients with LVH and severe LVH,the LVMI decreased significantly after roxadustat and rh EPO treatment,but there were no significant differences in LVMI changes between the two treatment groups.Compared to baseline,Hb,Alb,Lp(a),SF,unsaturated iron,and TIBC levels improved significantly in both groups after 6 months of treatment.The TC and LDL levels in the roxadustat group were significantly decreased,while rh EPO had no significant effect on lipid metabolism indexes.The increase of Alb in rh EPO group was more significant than that in roxadustat group,but there was no significant difference in the changes of other laboratory parameters.The results of multiple linear regression showed that the change of Hb and the presence of LVH at baseline were independent factors affecting the improvement of LVMI,that is,the increase of Hb was related to the improvement of cardiac remodeling.The effect of patients with LVH at baseline was better than that of patients without LVH.ConclusionsThis study is the first to compare the effects of roxadustat and rh EPO on cardiac structure and function,showing that elevated Hb is associated with decreased LVMI in dialysis patients,correction of anemia is associated with improved LVH in dialysis patients,and cardiac hypertrophy due to anemia is reversible.However,the beneficial effects of the two drugs on LVMI did not show clear superiority or inferiority in this study.In addition to the efficacy in the treatment of renal anemia,we found that roxadustat can simultaneously improved lipid metabolism and iron metabolism in patients,with less effect on blood pressure,and had better therapeutic effect and cardiovascular safety.Our findings may provide new insights into anemia management in dialysis patients.However,larger,more robust clinical trials are necessary to further evaluate the role of HIF-PHIs in reversing ventricular remodeling. |
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