Kidney Week

Abstract: TH-PO912

Reversible Central Hypothyroidism Associated with Roxadustat in Patients Undergoing Hemodialysis

Session Information

• Anemia and Iron Metabolism
  October 24, 2024 | Location: Exhibit Hall, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Anemia and Iron Metabolism

• 200 Anemia and Iron Metabolism

Authors

• Otsuka, Emiko, Nagasaki Daigaku Byoin, Nagasaki, Nagasaki, Japan

Emiko Otsuka, MD

• Kitamura, Mineaki, Nagasaki Daigaku Byoin, Nagasaki, Nagasaki, Japan

Mineaki Kitamura, MD, PhD

• Abe, Shinichi, Nagasaki Kidney Center, Nagasaki, Nagasaki, Japan

Shinichi Abe, MD

• Funakoshi, Satoshi, Nagasaki Kidney Center, Nagasaki, Nagasaki, Japan

Satoshi Funakoshi, MD, PhD

• Nishino, Tomoya, Nagasaki Daigaku Byoin, Nagasaki, Nagasaki, Japan

Tomoya Nishino, MD, PhD

Background

More than 90% of patients undergoing hemodialysis suffer from anemia. The conventional treatments involve the use of erythropoiesis-stimulating agents (ESAs) and iron supplementation. Recently, hypoxia-inducible factor-prolyl hydroxylase inhibitors (HIF-PHIs) have emerged as an alternative therapy for renal anemia. As roxadustat, one of HIF-PHIs, has been widely used, there have been several reports on central hypothyroidism associated with roxadustat. However, the prevalence and reversibility of roxadustat-associated central hypothyroidism in patients undergoing hemodialysis remain unclear.

Methods

We conducted a retrospective study at a single center. We included patients undergoing hemodialysis who were initially administered with roxadustat but later transitioned to ESA, and measured TSH, FT4, FT3 before, during, and after halting roxadustat treatment at the Nagasaki Renal Center from February 2020 to August 2023. We analyzed TSH, FT4, and FT3 levels in three periods: before starting roxadustat, during treatment with roxadustat, and after the discontinuation of roxadustat treatment. The Friedman test and the Bonferroni post hoc test were used to analyze.

Results

We analyzed 51 patients (mean age: 72.3 ± 10.7 years and 58.8% male). During the treatment, TSH significantly decreased from 2.46 (1.60–4.51) mU/l to 1.36 (0.72–2.41) mU/l(P<0.001) and FT4 decreased from 1.11 (0.97–1.24) mU/l to 0.92 (0.71–1.03) mU/l (P<0.001). After cessation, TSH and FT4 subsequently recovered to 2.56 (1.78–4.63) mU/l(P<0.001) and 1.05 (0.93–1.17) mU/l (P<0.001) (Figure). There were no significant differences in FT3 at the three points.

Conclusion

Roxadustat causes reversible central hypothyroidism in patients undergoing hemodialysis.