Early response to erythropoiesis-stimulating agents in non-dialysis chronic kidney disease patients

Kuwahara, Michio; Arai, Youhei; Takehara, Eriko; Sasaki, Yasunori; Yoshimine, Tomoharu; Kusaka, Keita; Shikuma, Satomi; Akita, Wataru; Uchida, Shinichi

doi:10.1007/s10157-015-1188-x

Cited by 3 publications

(2 citation statements)

References 25 publications

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“…No significant difference in DA or roxadustat AAD/6W was observed between DM+ and DM− patients. This is in contrast with previous reports 20 , 21 showing a correlation between DM and ESA hyporesponsiveness and may be due to several factors, including the small population analyzed.…”

Section: Discussioncontrasting

confidence: 99%

Factors affecting the doses of roxadustat vs darbepoetin alfa for anemia treatment in hemodialysis patients

et al. 2020

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Roxadustat is an oral hypoxia-inducible factor prolyl hydroxylase inhibitor for the treatment of anemia in chronic kidney disease (CKD). Emerging evidence suggests that roxadustat may be beneficial for patients who inadequately respond to erythropoiesis-stimulating agents (ESAs). This post-hoc analysis of a Japanese, double-blind, randomized, phase 3 study in hemodialysisdependent CKD patients treated with traditional ESAs assessed the impact of factors associated with ESA hyporesponsiveness on roxadustat and darbepoetin alfa (DA) doses required to maintain target hemoglobin. Endpoints included mean of average doses of roxadustat and DA per administration in the last 6 weeks (AAD/6W) by prior ESA-resistance index (ERI), iron repletion (transferrin saturation; ferritin), and high-sensitivity C-reactive protein (hs-CRP). Of 415 enrolled patients, 303 were randomized (roxadustat, n = 151; DA, n = 152). Weight-adjusted AAD/6W increased with increasing ERI for roxadustat (ERI <3.3, 0.89 mg/kg; ERI ≥8.4, 1.51 mg/kg) and DA (ERI <3.3, 0.26 μg/kg; ERI ≥8.4, 0.91 μg/kg); the weight-adjusted AAD/6W relative to within-arm mean AAD/6W showed a trend toward increased DA doses for the ERI ≥8.4 category (P = .089). AAD/6W remained stable for roxadustat but increased for DA with decreasing baseline iron repletion markers. The relationship between roxadustat doses and end of treatment (EoT) hs-CRP was not significant (estimated slope, −0.494; P = .814); a trend toward increased DA doses was observed with increasing EoT hs-CRP (estimated slope, 2.973; P = .075). Roxadustat doses required to maintain target hemoglobin appear to be less affected by factors that underlie ESA hyporesponsiveness, relative to DA; roxadustat may be beneficial for patients hyporesponsive to ESAs.

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Section: Discussioncontrasting

confidence: 99%

Factors affecting the doses of roxadustat vs darbepoetin alfa for anemia treatment in hemodialysis patients

et al. 2020

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“…This could be explained by the numerous studies confirming hypertension as a common but frequently overlooked adverse effect of rhEPO therapy (22,23). Furthermore, as an independent influencing factor of inflammation, DM seems to be less sensitive than Hs-CRP and has been reported to cause erythropoietin hyporesponsiveness (24,25). Therefore, in clinical practice, patients with hypertension or DM often avoid rhEPO injections.…”

Section: Discussionmentioning

confidence: 99%

Comparison of efficacy of roxadustat and erythropoietin for the treatment of renal anemia in patients with chronic kidney disease: a retrospective study

Jin¹,

Zhang²,

Luo³

et al. 2022

Transl Androl Urol

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Background: Renal anemia is a common complication in patients with end-stage renal disease (ESRD).Both roxadustat and recombinant human erythropoietin (rhEPO) are alternative option for patients with renal anemia. However, the adverse events of rhEPO limited the wide use of it and the concrete difference of real clinical efficacy of rhEPO and roxadustat was still uncertain. This study aimed to assess the clinical efficacy of roxadustat for improving renal anemia in patients with chronic kidney disease.Methods: A retrospective cohort study of 790 consecutive patients with renal anemia treated with roxadustat and rhEPO was conducted at the Zhejiang Provincial People's Hospital. Patients were classified into two groups: roxadustat (n=95) and rhEPO (n=695). Baseline characteristics were compared in two groups. After propensity-score matching at a 1:3 ratio, we compared the efficacy of roxadustat and rhEPO in improving anemia, mainly using the Mann-Whitney U test. The follow-up period lasted 24 weeks. Results:The baseline characteristics were comparable between the two groups after propensity-score matching. There were no significant differences in the hemoglobin levels and estimated glomerular filtration rates (eGFRs) of the two groups before roxadustat or rhEPO treatment (P>0.05). The hemoglobin level after 4 weeks of treatment was 96 g/L in the roxadustat group, and the increase from baseline was 10 g/L; in the rhEPO group, these values were 87 and 6 g/L, respectively (P<0.001). After 12 weeks of treatment, the hemoglobin level and change from baseline were 105 and 15 g/L in the roxadustat group and 94 and 11 g/L in the rhEPO group, respectively (P<0.001). Similar results were observed after 24 weeks of treatment; the hemoglobin level and change from baseline were 105 and 17 g/L in the roxadustat group and 97 and 14 g/L in the rhEPO group (P=0.001).Conclusions: This retrospective study demonstrated that orally administered roxadustat improved hemoglobin levels more than rhEPO in patients with CKD and anemia.

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Low white blood cell count is independently associated with chronic kidney disease progression in the elderly: the CKD-ROUTE study

et al. 2017

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Early response to erythropoiesis-stimulating agents in non-dialysis chronic kidney disease patients

Abstract: The study results suggest that TSAT is the best predictor of the initial 12-week responsiveness to ESA, irrespective of the type. Variables not investigated in this study also affect responsiveness to ESA in Japanese pre-dialysis CKD patients.

Cited by 3 publications

References 25 publications

Factors affecting the doses of roxadustat vs darbepoetin alfa for anemia treatment in hemodialysis patients

Factors affecting the doses of roxadustat vs darbepoetin alfa for anemia treatment in hemodialysis patients

Comparison of efficacy of roxadustat and erythropoietin for the treatment of renal anemia in patients with chronic kidney disease: a retrospective study

Low white blood cell count is independently associated with chronic kidney disease progression in the elderly: the CKD-ROUTE study

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