Abstract

Background: Anemia is common in maintenance hemodialysis (MHD). Therapy with erythropoiesis-stimulating agents (ESAs) may be limited by inflammation-related hyporesponsiveness and safety concerns. Real-world evidence on roxadustat across baseline anemia severities is limited. Materials and methods: In this single-center retrospective cohort, 300 MHD patients who switched from ESAs to roxadustat monotherapy were grouped by baseline hemoglobin (Hb): severe < 80 g/L (n = 82), moderate 80 – 99 g/L (n = 137), and mild 100 – 110 g/L (n = 81). The primary outcome was sustained Hb target achievement (100 – 120 g/L for ≥ 2 consecutive visits within 12 weeks without rescue therapy). Hb trajectories were assessed using linear mixed-effects models, and predictors of target achievement were identified by multivariable logistic regression with false discovery rate adjustment. Results: At 12 weeks, sustained Hb achievement increased with baseline Hb: 46.3% (severe), 64.2% (moderate), and 76.5% (mild) (q = 0.0012). Hb variability decreased across groups (time-weighted coefficients of variation 7.5, 6.1, and 5.2%; q = 0.008). Early Hb rise was fastest in severe anemia (+1.85 vs. +1.24 vs. +0.74 g/L/week over weeks 0 – 4; q = 0.028). Adverse events occurred in 47.7%, mostly grade 1 – 2, without between-group differences in serious events or discontinuation. Higher C-reactive protein (per 10 mg/L, OR 0.42; q = 0.012) and poor prior ESA response (OR 0.60; q = 0.013) predicted lower target attainment, whereas higher prealbumin (per 10 mg/L, OR 1.35; q = 0.004), IV iron (OR 1.52; q = 0.021), and ≥ 50% dose titration (OR 1.59; q = 0.019) predicted higher attainment. Conclusion: Roxadustat improved and stabilized Hb across anemia severities in MHD, with best control in milder anemia; inflammation, nutrition, prior ESA response, iron use, and dose titration influenced success.


Author Details

Authors

• Jiao Yuan¹,²
• Yingsong Jiang¹,²

Departments

• ¹ Internal Medicine, Chongqing Medical University, Chinese Academy of Sciences (Chongqing College), and
• ² Department of Nephrology, Chongqing General Hospital, Chongqing, China

Address

Yingsong Jiang, PhD candidate, Internal Medicine, Chongqing Medical, University, Chinese Academy of Sciences (Chongqing College), No. 1, Medical College Road, Yuzhong District, Chongqing, 400016, China
Email: [email protected]

Citation