ASN's Mission

ASN leads the fight to prevent, treat, and cure kidney diseases throughout the world by educating health professionals and scientists, advancing research and innovation, communicating new knowledge, and advocating for the highest quality care for patients.

learn more

Contact ASN

1401 H St, NW, Ste 900, Washington, DC 20005

email@asn-online.org

202-640-4660

The Latest on Twitter

Kidney Week

Abstract: PO1030

Role of Roxadustat in Improving Erythropoiesis-Stimulating Agent (ESA)-Resistant Anemia in Patients on Maintenance Hemodialysis

Session Information

Category: Diabetic Kidney Disease

  • 602 Diabetic Kidney Disease: Clinical

Authors

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

Roxadustat, an oral hypoxia-inducible factor (HIF) prolyl hydroxylase inhibitor, is shown to stimulate erythropoiesis thus improving iron metabolism. Again, while hyperglycemic states are known to be associated with a decreased tissue hypoxia response, to date, roxadustat has not been revaluated for its role in improving anemia in patients with or without diabetes in clinical settings.

Methods

A total of 64 hemodialysis patients being treated with epoetin α (9000 units weekly) participated in the study after giving informed consent. They were switched from intravenous epoetin α to oral roxadustat (100 mg 3 times weekly) therapy and were assessed 8 weeks later for improvements in anemia, as well as for changes in parameters for iron metabolism and C-reactive protein (CRP).

Results

The study included 39 patients without diabetes (mean age, 71.1 ± 12.1 years; mean dialysis vintage, 7.5 ± 7.4 years; mean GA, 16.2 ± 2.9%) and 27 patients with diabetes (mean age, 70.3 ± 10.3 years; mean dialysis vintage, 5.9 ± 5.5 years; mean GA, 24.9 ± 5.5%). As shown in Table, after 8 weeks the Hb concentration was significantly increased from 10.3 ± 0.8 g/dL at baseline to 10.7 ± 1.3 g/dL in patients without diabetes (P = 0.03) but was not increased in patients with diabetes (from 10.4 ± 0.6 at baseline to 10.5 ± 1.1 g/dL). Again, the serum iron, ferritin concentrations and the transferrin saturation ratio were decreased, irrespective of whether or not they had diabetes, with no change shown in serum CRP level.

Conclusion

Switching hemodialysis patients with ESA-resistant anemia from ESA to roxadustat led to improvements in anemia only in those without diabetes, while study results suggested the involvement of mechanisms, other than impaired iron utilization or inflammation, in the impairment of hematopoiesis in those with diabetes.

Effects of Roxadustat on HD Patients without or with Diabetes
  without DM  with DM 
 Week 0Week 4Week 8Week 0Week 4Week 8
Hb (g/dL)10.3±0.810.9±1.2*10.7±1.3*10.4±0.610.4±1.010.5±1.1
iron (μg/dL)53.3±17.749.1±25.745.6±20.1*43.4±19.937.1±20.5*37.6±24.9*
ferritin (g/dL)49.7±36.240.7±+47.5*46.6±62.135.8±36.719.1±17.0*15.6±22.2*
TSAT0.19±0.050.15±0.08*0.15±0.10*0.16±0.060.12±0.07*0.10±0.07*
CRP (mg/dL)0.27±0.030.22±0.050.30±0.190.22±0.090.25±0.090.27±0.10

* p<0.05

Funding

  • Private Foundation Support