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Nephro Pharmacology

Comparative analysis of roxadustat efficacy between maintenance hemodialysis and peritoneal dialysis patients 

Liling Zhang, Yan Huang, Defeng Yin, Tingting Zhu, Qi Liu, Ying Li, and Linwang Gan

Volume 101 (2024) p. 34 - 42

Abstract

Clinical Nephrology, Vol. 101 – No. 1/2024 (34-42)

Comparative analysis of roxadustat efficacy between maintenance hemodialysis and peritoneal dialysis patients 

Liling Zhang¹*, Yan Huang¹*, Defeng Yin², Tingting Zhu¹, Qi Liu¹, Ying Li¹, and Linwang Gan¹

¹Department of Nephrology, ²Department of Emergency, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan Province, China
Background: This study evaluated the comparative efficacy of roxadustat for renal anemia between patients on maintenance hemodialysis (HD) and peritoneal dialysis (PD).
Materials and methods: 93 maintenance dialysis patients who regularly followed up from August 2015 to June 2021 were enrolled. Despite receiving a therapeutic dose ≥ 12,000 U/week of erythropoiesis-stimulating agents (E+SA) in the past 12 weeks, this had not worked very well. Subjects were assigned to the HD group (n = 60) or the PD group (n = 33) based on their dialysis treatment modality. All patients received oral roxadustat and were followed up for 24 weeks, after which their hemoglobin, serum iron, transferrin saturation, and ferritin were tested.
Results: We observed that the hemoglobin level of PD patients was significantly increased from 76.1 ± 15.7 g/L to 106 ± 23.8 g/L (p < 0 .001), while it significantly increased from 73.8 ± 12.9 g/L to 100.7 ± 20.2 g/L (p < 0.001) in the HD patients. After 1 and 3 months of roxadustat treatment, the hemoglobin level and its change in the PD group was significantly higher compared to that in the HD group despite the higher dose of roxadustat in the latter group. In addition, roxadustat was noted to reduce cholesterol levels and stabilize serum iron levels in parallel with improving hemoglobin levels.
Conclusion: Roxadustat can effectively increase the hemoglobin level of maintenance dialysis patients, even in those with low erythropoietin response or erythropoietin resistance, and, more importantly, its efficacy in PD patients was more significant.

*Contributed equally.Correspondence to:
Linwang Gan, MD
Department of Nephrology
the Affiliated Hospital of Southwest Medical University
No. 25 Taiping Street
Luzhou 646000, Sichuan Province, China
Email: [email protected]

Original

Peritoneal dialysis-related complication: Can diagnostic accuracy be achieved at low iodinated contrast media dose using dual-layer spectral detector CT? 

Jiao Bai, Yu Zhang, Fang Wang, Linwang Gan, Dongmei Zhao, and Jian Shu

Volume 103 (2025) p. 108 - 115

Abstract

Clinical Nephrology, Vol. 103 – No. 2/2025 (108-115)

Peritoneal dialysis-related complication: Can diagnostic accuracy be achieved at low iodinated contrast media dose using dual-layer spectral detector CT? 

Jiao Bai¹#², Yu Zhang³, Fang Wang², Linwang Gan⁴, Dongmei Zhao², and Jian Shu¹#²

¹Jinan University, Guangzhou, Guangdong, ²Department of Radiology, the Affiliated Hospital of Southwest Medical University, Luzhou, ³Department of Radiology, The First People’s Hospital of Yibin, Yibin, and ⁴Department of Nephrology, the Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, China
Introduction: Computed tomography peritoneography (CTp) is pivotal for evaluating peritoneal dialysis (PD)-related complications, yet it comes with drawbacks, specifically exposure to iodinated contrast media (ICM). This study aimed to explore the feasibility of reducing ICM dosage utilizing spectral detector CT (SDCT).
Materials and methods: 35 rabbits were strategically divided into 7 groups (A – G) according to the ICM concentration ratio in the injection protocol, with respective doses of 10, 15, 20, 25, 30, 40, and 50 mL/2L. The CTp injection protocol involved a 300-mL mixture of non-ionic ICM omnipaque (350 mgI/mL) and peritoneal dialysate (1.5% lactate, 2 L), followed by scans using dual-layer SDCT. Virtual monoenergetic images (VMIs) at 4 distinct energy levels (40 – 70 keV, in 10-keV steps), iodine maps (IMs), and effective atomic number (Zeff) maps were subsequently reconstructed. Both quantitative and qualitative image assessments were conducted, and the parameters from these analyses were compared across images from groups A – G and traditional 50 mL/2L 120-kVp images. In post-determination of the optimal concentration and reconstructions, we illustrated their applications in patients with suspected PD-related complications.
Results: The quantitative image quality (IQ) of 15 mL/2L VMIs at 40 keV surpassed that of the 50 mL/2L 120-kVp images (p < 0.05). Furthermore, the diagnostic performance utilizing 15 mL/2L VMIs40 keV, when combined with IMs and Zeff maps, was found to be optimal.
Conclusion: The employment of SDCT in CTp allows for a substantial reduction in the ICM dose by 70%, compared to the benchmark concentration of 50 mL/2L, without compromising diagnostic precision.

J.B. and Y.Z. contributed equally to this work.Correspondence to:
Jian Shu, MD
Jinan University
601 Huangpu Avenue West
Tianhe District, Guangzhou, Guangdong, China
Email: [email protected]

Original

Relationship of serum α-Klotho with diabetic kidney disease and mortality in diabetes: A population-based observational study 

Liling Zhang, Di Fan, Tingting Zhu, Lei Geng, Linwang Gan, Santao Ou, Defeng Yin, and Yong Xu

Volume 105 (2026) p. 297 - 307

Abstract

Clinical Nephrology, Vol. 105 – No. 5/2026 (297-307)

Relationship of serum α-Klotho with diabetic kidney disease and mortality in diabetes: A population-based observational study 

Liling Zhang¹, Di Fan², Tingting Zhu¹, Lei Geng¹, Linwang Gan¹, Santao Ou¹, Defeng Yin³, and Yong Xu⁴

¹Department of Nephrology, ²Department of Anesthesiology, ³Department of Emergency, and ⁴Department of Endocrinology and Metabolism, The Affiliated Hospital, Southwest Medical University, Luzhou, China
This study aimed to investigate the associations between serum α-Klotho levels and diabetic kidney disease (DKD), as well as all-cause mortality among individuals with diabetes. We included participants from the National Health and Nutrition Examination Survey (NHANES) between 2007 and 2016. Multivariable logistic regression and Cox proportional hazards models were used to evaluate the relationships of serum α-Klotho with DKD and mortality, respectively. Restricted cubic splines were applied to examine potential nonlinear associations. Subgroup analyses were performed to assess the robustness of the findings. A total of 3,098 participants were enrolled. The fully adjusted odds ratio (95% confidence interval (CI)) for the association between serum α-Klotho and DKD was 0.47 (0.33, 0.67; p < 0.001). Similarly, the hazard ratio for all-cause mortality was 0.61 (0.36, 0.96; p = 0.043). Restricted cubic spline analyses revealed nonlinear relationships between serum α-Klotho and both DKD and all-cause mortality. Kaplan–Meier curves indicated that participants in the lower quartiles of serum α-Klotho had significantly reduced survival probabilities. After Bonferroni correction, subgroup analyses showed no significant interactions between serum α-Klotho and all-cause mortality across populations. In conclusion, serum α-Klotho is significantly associated with DKD and all-cause mortality in diabetes.Correspondence to:
Yong Xu
Department of Endocrinology and Metabolism
The Affiliated Hospital
Southwest Medical University
No. 25, Taiping Street,
Jiangyang District, Luzhou 646000, China
Email: [email protected]

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