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Abstract: PO0266

Effects of Roxadustat Treatment on Serum Parathyroid Hormone (PTH) in Hemodialysis Patients with Erythropoiesis-Stimulating Agent (ESA) Resistant Anemia

Session Information

Category: Anemia and Iron Metabolism

  • 200 Anemia and Iron Metabolism

Authors

  • Hashiguchi, Jyunichiro, Nagasaki Kidney Center, Nagasaki, Japan
  • Funakoshi, Satoshi, Nagasaki Kidney Center, Nagasaki, Japan
  • Sawase, Kenji, Nagasaki Kidney Center, Nagasaki, Japan
  • Kawazu, Tayo, Nagasaki Kidney Center, Nagasaki, Japan
  • Hayashi, Kanako, Nagasaki Kidney Center, Nagasaki, Japan
  • Yamaguchi, Kosei, Nagasaki Kidney Center, Nagasaki, Japan
  • Kitamura, Mineaki, Nagasaki Kidney Center, Nagasaki, Japan
  • Harada, Takashi, Nagasaki Kidney Center, Nagasaki, Japan
  • Nishino, Tomoya, Nagasaki University Hospital, Nagasaki, Japan
Background

Roxaduastat, an oral HIF-prolyl hydroxylase inhibitor, is shown to stimulate erythropoiesis thereby improving iron metabolism. Of note, recent research suggests that iron utilization plays a key role in bone turnover in hemodialysis patients.

Methods

A total of 64 hemodialysis patients with ESA-resistant anemia despite high-dose epoetin α (3000 units 3 times weekly) therapy participated in the study after giving informed consent. Patients were switched from intravenous epoetin α to oral roxaduastat therapy (100 mg 3 times weekly), with no dose change in any of the iron supplements, calcimimetics or vitamin D formulations being used, and were assessed after 8 weeks of roxaduastat therapy for improvements in anemia, as well as for changes in parameters related to iron metabolism and bone turnover.

Results

The study included 39 men and 25 women (age, 70.8 ± 11.8 years; Hb concentration, 10.3 ± 1.2 g/dL). After 8 weeks, the Hb concentration tended to be increased (P = 0.06). As shown in Table, the serum iron, ferritin concentration and TSAT significantly decreased (p < 0.05), suggesting increased iron utilization. Again, the serum calcium concentration was significantly decreased from 8.54 to 8.36 mg/dL, while the intact-PTH (i-PTH) concentration was significantly decreased from 98.61 to 75.80 pg/mL (P < 0.001).

Conclusion

Switching hemodialysis patients with ESA-resistant anemia from intravenous ESA to oral roxaduastat therapy may result in a decrease in their serum PTH concentrations presumably through improved iron utilization, thus potentially improving their bone mineral metabolism.

Effects of Roxadustat Treatment on HD Patients with ESA-resistant Anemia
 Week 0Week 4Week 8
Hb (g/dL)10.36±0.8510.62±1.2810.52+±1.28
iron (μg/dL)49.48±17.6945.86±25.75*45.61±23.15*
ferritin (g/dL)63.87±66.7256.08±97.60*46.96±62.61*
TSAT0.18±0.060.14±0.08*0.14±0.10*
calcium (mg/dL)8.54±0.658.43±0.72*8.36±0.81*
i-PTH (pg/mL)98.61±88.7270.38±61.13**75.80±75.86**

* p<0.05, ** p<0.01

Funding

  • Private Foundation Support