#3513 A multicenter retrospective study of erythropoietin combined with low-dose roxadustat in the treatment of renal anemia in hemodialysis patients

Abstract Background and Aims To explore the efficacy of erythropoietin (EPO) combined with low-dose roxadustat in the treatment of hemodialysis patients with renal anemia whose hemoglobin (Hb) levels did not reach the guideline-recommended targets with EPO alone. Method This retrospective study included patients undergoing hemodialysis from January 2020 to December 2023 at three general hospitals in Beijing. Patients included were those whose Hb levels could not be maintained within the guideline-recommended range with EPO alone, for whom increasing EPO doses posed risks, or who had already reached the maximum EPO dose per the drug label, and those who could not afford full conversion to roxadustat. Changes in Hb levels and influencing factors before and after combination therapy were analyzed. Results A total of 125 patients were included (74 males, 50 females, mean age 61 ± 14 years, range 29–89 years). The median dialysis vintage was 55 ± 67 months (range 5–370 months). Primary diseases included diabetic nephropathy (48 cases), glomerulonephritis (42 cases), hypertensive nephropathy (10 cases), ADPKD (9 cases), tubulointerstitial nephropathy (3 cases), and unknown etiology (13 cases). Hb levels were persistently <110 g/L for 3 months before adding roxadustat. At the start of combination therapy, Hb was 96.66 ± 15.86 g/L, which increased to 102.64 ± 20.48 g/L (P = 0.001) at 1 month and 110.70 ± 16.07 g/L (P < 0.001) at 3 months. The average roxadustat dose was 197 ± 92 mg/week, approximately two-thirds of the recommended dose per the label. No significant changes were observed in EPO dose (P > 0.05), intravenous iron dose, transferrin saturation (TSAT), ferritin (SF), dialysis parameters, adequacy (KT/V), us-CRP, or iPTH levels (all P > 0.05). No significant adverse events were reported. Conclusion Low-dose roxadustat combined with EPO is safe and effective for hemodialysis patients with renal anemia whose Hb levels cannot be maintained within target ranges with EPO alone.