ASN's Mission

To create a world without kidney diseases, the ASN Alliance for Kidney Health elevates care by educating and informing, driving breakthroughs and innovation, and advocating for policies that create transformative changes in kidney medicine throughout the world.

learn more

Contact ASN

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

email@asn-online.org

202-640-4660

The Latest on X

Kidney Week

ASN / Education & Meetings / Kidney Week /

Please note that you are viewing an archived section from 2023 and some content may be unavailable. To unlock all content for 2023, please visit the archives.

Abstract: TH-PO978

Roxadustat vs. Erythropoiesis in the Nephroprotection Treatment of Patients with CKD and Anemia

Session Information

Category: Anemia and Iron Metabolism

  • 200 Anemia and Iron Metabolism

Authors

  • Ouyang, Yan, Shanghai Jiao Tong University Medical School Affiliated Ruijin Hospital, Shanghai, China
  • Ren, Hong, Shanghai Jiao Tong University Medical School Affiliated Ruijin Hospital, Shanghai, China
  • Xie, Jingyuan, Shanghai Jiao Tong University Medical School Affiliated Ruijin Hospital, Shanghai, China
  • Fu, Xiaocen, Shanghai Jiao Tong University Medical School Affiliated Ruijin Hospital, Shanghai, China
  • Li, Xiao, Shanghai Jiao Tong University Medical School Affiliated Ruijin Hospital, Shanghai, China
  • Wang, Weiming, Shanghai Jiao Tong University Medical School Affiliated Ruijin Hospital, Shanghai, China
  • Chen, Nan, Shanghai Jiao Tong University Medical School Affiliated Ruijin Hospital, Shanghai, China
Background

Roxadustat has been approved for patients with chronic kidney disease(CKD) and renal anemia in China since 2019. It is now widely used around the world. Although studies have found that roxadustat may improve tissue fibrosis, inflammation, and oxidative stress, there have been few studies on its nephroprotection. We aim to elucidate the nephroprotection of roxadustat versus erythropoiesis-stimulating agent (ESA) in CKD patients with anemia.

Methods

We conducted a retrospective cohort study of CKD patients with anemia diagnosed in ruijin hospital between January 2010 and December 2022. CKD patients aged 14 years at diagnosis, coexisting with anemia, an estimated glomerular filtration rate(eGFR) greater than 15 ml/min/1.73m2, 24-hour urine protein, follow-up data, and received roxadustat three times a week or ESA, were included. The patients were 1:1 assigned to two groups by propensity score matching based on indicators including sex, age, eGFR, 24-hour urine protein and follow-up time. The primary outcome was composite renal endpoint defined as a 50% decline in eGFR and end-stage kidney disease (ESKD).

Results

A total of 288 patients were included after PSM. The significantly lower incident of composite renal outcomes in the roxadustat group compared with the ESA group were observed (39.58% vs. 26.39%, p=0.017). By multivariate Cox regression analysis, roxadustat was associated with a lower risk for the composite kidney outcomes compared to ESA (HR=0.61, 95% CI: 0.40-0.94, p=0.023) after adjusting for age, gender, baseline eGFR, 24-hour urine protein, MAP, and hemoglobin. Moreover, subgroup analysis showed similar results in different subgroups defined by hyperlipidemia, high urine acid. Notably, in the roxadustat group, eGFR decreased at a slower rate than in the ESA group [median eGFR slope: -2.14 vs. -7.46 ml/min/1.73m2/yrs, p=0.099]. We found that roxadustat group had a higher hemoglobin level than the ESA group (110.64±17.13 vs. 104.33±23.14 g/L, p=0.04). Compared to the ESA group, the roxadustat group had more 50% decline in proteinuria after 12 months (43.06% vs. 29.86%, p=0.02).

Conclusion

Roxadustat is superior than ESA in treating CKD patients combined with anemia, especially for nephroprotection. Our findings need to be validated in further.