Comparison of efficacy of roxadustat and erythropoietin for the treatment of renal anemia in patients with chronic kidney disease: a retrospective study

Abstract

Background: Renal anemia is a common complication in patients with end-stage renal disease (ESRD).Both roxadustat and recombinant human erythropoietin (rhEPO) are alternative option for patients with renal anemia. However, the adverse events of rhEPO limited the wide use of it and the concrete difference of real clinical efficacy of rhEPO and roxadustat was still uncertain. This study aimed to assess the clinical efficacy of roxadustat for improving renal anemia in patients with chronic kidney disease.Methods: A retrospective cohort study of 790 consecutive patients with renal anemia treated with roxadustat and rhEPO was conducted at the Zhejiang Provincial People's Hospital. Patients were classified into two groups: roxadustat (n=95) and rhEPO (n=695). Baseline characteristics were compared in two groups. After propensity-score matching at a 1:3 ratio, we compared the efficacy of roxadustat and rhEPO in improving anemia, mainly using the Mann-Whitney U test. The follow-up period lasted 24 weeks. Results:The baseline characteristics were comparable between the two groups after propensity-score matching. There were no significant differences in the hemoglobin levels and estimated glomerular filtration rates (eGFRs) of the two groups before roxadustat or rhEPO treatment (P>0.05). The hemoglobin level after 4 weeks of treatment was 96 g/L in the roxadustat group, and the increase from baseline was 10 g/L; in the rhEPO group, these values were 87 and 6 g/L, respectively (P<0.001). After 12 weeks of treatment, the hemoglobin level and change from baseline were 105 and 15 g/L in the roxadustat group and 94 and 11 g/L in the rhEPO group, respectively (P<0.001). Similar results were observed after 24 weeks of treatment; the hemoglobin level and change from baseline were 105 and 17 g/L in the roxadustat group and 97 and 14 g/L in the rhEPO group (P=0.001).Conclusions: This retrospective study demonstrated that orally administered roxadustat improved hemoglobin levels more than rhEPO in patients with CKD and anemia.

Correlation between blood concentration of roxadustat and clinical efficacy in patients with anemia of chronic kidney disease

“…Anemia is a common complication of CKD caused by impaired oxygen sensing during renal failure. [ 14 ] As a HIF prolyl hydroxylase inhibitor, the novel agent roxadustat may increase endogenous erythropoietin concentrations by regulating the HIF, which is activated via the inhibition of certain activated domains. [ 15 ] In our study, roxadustat demonstrated prospective efficacy for the treatment of CKD patients with anemia, the Hb level after roxadustat treatment was significantly higher than the baseline value, and the iron metabolism-related indicators were significantly improved, which is consistent with previous studies.…”

Exploring The Impact Of Dialysis On Neurological Conditions: Insights From Biochemical Data In Chronic Kidney Disease

“…Rinsing is the only way to eliminate creatinine because the body can't absorb or use it again. This means plasma creatinine concentrations show how well the kidneys filter waste, and high creatinine levels make the kidneys less effective (Jin et al, 2024).…”

Short-term effect of low-dose roxadustat combined with erythropoiesis-stimulating agent treatment for erythropoietin-resistant anemia in patients undergoing maintenance hemodialysis

“…The worldwide prevalence of chronic kidney disease (CKD) is increasing. In China, there are an estimated 120 million patients with CKD and approximately 2% will progress to end-stage renal disease (ESRD) ( 1 , 2 ).…”

“…ESA hyporesponsiveness is associated with higher mortality rates and poorer clinical outcomes. The anemia must be corrected effectively, which often requires higher doses of rhuEPO, leading to a higher incidence of treatment-related adverse events, such as tumors, elevated blood pressure, endocrine system dysfunction, stroke, and cardiovascular events ( 2 , 7 – 15 ). Although it remains unclear whether adverse effect prognoses are a result of the direct toxicity of ESA or of underlying conditions requiring high doses of ESA ( 15 ), we should limit the dosage to a suitable range, which can increase the HB concentration without increasing the risk of side effects.…”

“…Roxadustat (FG-4592), a novel oral agent, has been incorporated into the therapeutic regimen for anemia in patients with CKD with or without hemodialysis ( 16 – 19 ). Roxadustat is a hypoxia-inducible factor prolyl hydroxylase inhibitor(HIF-PHI) that increases endogenous erythropoietin concentrations and improves iron absorption and utilization by mediating hypoxia-inducible factors(HIF) ( 2 ). Roxadustat can significantly improve the Hb concentration and reduce the need for intravenous iron supplementation and transfusion ( 20 , 21 ).…”