Efficacy and safety comparison of erythropoietin and roxadustat in the treatment of anemia in pre-dialysis and dialysis patients with chronic kidney disease: a multicenter real-world retrospective study

 

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https://storage.unitedwebnetwork.com/files/1099/69221fc5115d49592467f03ec434afdb.pdf
Efficacy and safety comparison of erythropoietin and roxadustat in the treatment of anemia in pre-dialysis and dialysis patients with chronic kidney disease: a multicenter real-world retrospective study

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Lihua
Wang
Lihua Wang wlh201cn@126.com 2nd Hospital of Tianjin Medical University Department of Kidney Disease and Blood Purification Centre Tianjin China *
Yueqi Cao onecyq@126.com 2nd Hospital of Tianjin Medical University Department of Kidney Disease and Blood Purification Centre Tianjin China -
Weijie Yuan ywj4169@163.com Shanghai First People's Hospital Department of Nephrology Shanghai China -
Chuanming Hao chuanming.hao@Vanderbilt.Edu Fudan University Affiliated Huashan Hospital Department of Nephrology Shanghai China -
Li Yao liyao_cmu@163.com The First Affiliated Hospital of China Medical University, Department of Nephrology Shenyang China -
Pei Yu yupei@tmu.edu.cn 2nd Hospital of Tianjin Medical University Department of kidney disease and blood purification center Tianjin China -
Changlin Mei chlmei1954@126.com Department of Nephrology Shanghai Changzheng Hospital, Second Affiliated Hospital of Naval Medical University Shanghai China -
 
 
 
 
 
 
 
 

To compare the safety and efficacy of erythropoietin and roxadustat in the treatment of anemia in chronic kidney disease (CKD) patients during the peridialysis period, providing a reference for clinical practice

This multicenter retrospective study collected clinical data from 40,324 patients with stage 5 CKD and anemia treated with either 10,000 IU erythropoietin or roxadustat between January 1, 2015, and December 31, 2021, across 82 hospitals (42 tertiary hospitals and 40 secondary hospitals). Patients were divided into an erythropoietin group and a roxadustat group based on their treatment regimen. Propensity score matching (PSM) was used for 1:4 matching, resulting in 545 patients in the roxadustat group and 1,804 patients in the erythropoietin group. Baseline characteristics, incidence of cardiovascular and cerebrovascular events, thrombotic events, major adverse cardiovascular events (MACE+), number of hospitalizations due to complications, and length of hospital stay were compared between the two groups. Medication dosage and changes in hemoglobin (Hb) levels (compared to baseline) were recorded for three months after treatment initiation

After PSM, there were no statistically significant differences in baseline characteristics between the two groups (P>0.05).  Within the first six months and one year of initial treatment and during the first three months post-dialysis, the roxadustat group had higher rates of cardiovascular and cerebrovascular events, MACE+, and hospitalization for complications compared to the erythropoietin group (P<0.001). However, no significant differences were observed between the groups in these outcomes during the one-year follow-up after the peri-dialysis period (P>0.05). Hb changes in the first month of treatment were greater in the erythropoietin group than in the roxadustat group (P<0.001), but lower in the second month (P=0.005), with no significant difference by the third month (P=0.331). A higher proportion of patients in the erythropoietin group maintained Hb levels within the target range after three months of continuous treatment (P=0.021).

 For anemia in stage 5 CKD patients during the peridialysis period, erythropoietin demonstrated superior cardiovascular safety compared to roxadustat and was more effective in improving Hb levels in the short term

Kewords