Impact of Roxadustat on Anemia Management in Infected Patients Undergoing Long-Term Dialysis: A Retrospective Cohort Analysis

Lulu Wang^1*Huimin Qiu²Xinqi Tan³Jing Liu⁴Ting Yang^1*Chunming Jiang^2*

• ¹Department of Pharmacy, Nanjing Drum Tower Hospital, Nanjing, China
• ²Department of Nephrology, Nanjing Drum Tower Hospital Clinical College of Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing, China
• ³Department of Pharmacy, Nanjing Drum Tower Hospital, School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing, China
• ⁴Department of Nephrology, Nanjing University Medical School Affiliated Nanjing Drum Tower Hospital, Nanjing, China

The efficacy of oral roxadustat in dialysis patients with renal anemia and overt infections remains uncertain. In this retrospective cohort study, 2816 such patients were screened, of whom 167 were enrolled and assigned to either roxadustat (n = 88) or recombinant human EPO (rHuEPO; n = 79) treatment. Baseline hemoglobin levels were 90.3 ± 15.2 g/L and 91.9 ± 17.8 g/L, respectively. All patients received a mean of 10.6 ± 3.3 days of infection treatment. Types of infection included pulmonary, peritoneal dialysis-associated peritonitis, catheter-related, urinary tract, and others. Compared with rHuEPO, roxadustat led to significantly greater increases in hemoglobin and ΔHb, and more pronounced improvements in ferritin, transferrin saturation (TSAT), and hepcidin levels following infection. The analysis demonstrated that TSAT, hepcidin, dialysis modality, residual renal function, infection type, and PCT levels play critical roles in mediating the efficacy of roxadustat under active infection conditions. Among peritoneal dialysis patients, roxadustat was associated with significantly greater improvements in ΔHb, ferritin, and TSAT compared to rHuEPO. ΔHb values varied by infection type, with significantly higher increases in peritoneal dialysis-associated peritonitis and a trend toward larger ΔHb in other infections relative to pulmonary infections. Based on procalcitonin levels, more severe infections were correlated with lower ΔHb values. In conclusion, roxadustat was more effective than rHuEPO in ameliorating renal anemia in infected dialysis patients.