Long-term efficacy, safety, and medication compliance of roxadustat on peritoneal dialysis patients with renal anemia affected by the COVID-19 pandemic: a retrospective study

Abstract

Background: Current studies have limited data on long-term treatment safety and medication compliance of roxadustat for renal anemia in peritoneal dialysis (PD) patients. We aimed to analyze the long-term efficacy, safety, and medication compliance of roxadustat in the treatment of renal anemia in patients with PD who discontinued recombinant human erythropoietin (rhEPO) treatment due to the corona virus disease 2019 (COVID-19) outbreak.Methods: We retrospectively collected patients who were switched from rhEPO to roxadustat in our hospital due to the pandemic. The criteria for subject inclusion: aged >18 years with a dialysis vintage >3 months, without malignant tumor, no severe cardiovascular and cerebrovascular diseases, and not combined hemodialysis. Patients were followed up until the end of December 2021. Hemoglobin (Hb), red blood cell (RBC) and hematocrit (Hct) were recorded at baseline, month 1-12 and month 20, and iron parameters at baseline, 3, 6, 9, 12, and 20 months were collected. The Morisky Medication Adherence Scale-8 (MMAS-8) was used to score medication compliance during rhEPO treatment and roxadustat treatment, and adverse reactions occurred during treatment were collected. The efficacy and medication compliance of roxadustat were analyzed using Wilcoxon rank sum test or t-test.Results: The median follow-up time was 21.1 (20.6, 21.7) months. After 1 month of treatment, the Hb level was significantly increased by 9.4 g/L (95% CI: 6.0-12.8 g/L) compared with the baseline, follow up at 20 months showed the Hb level had remained stable, increased by 20.7 g/L (95% CI: 15.9-25.4 g/L) compared with before treatment. At the beginning of treatment, total iron binding capacity increased, transferrin saturation and serum ferritin decreased, serum iron remained stable during treatment. During roxadustat treatment, no patient discontinued treatment due to the pandemic, and the Morisky score was improved compared with that during rhEPO treatment [5.75 (4.25, 6.00) vs. 6.75 (5.75, 7.00), P=0.000].There were no serious adverse events associated with roxadustat were observed.Conclusions: Roxadustat can effectively improve anemia and had good tolerance in patients undergoing PD who have difficult using rhEPO, and the medication compliance was better than rhEPO during the COVID-19.

Effects of the Omicron variant of coronavirus disease 2019 on anaemia treatment for patients undergoing peritoneal dialysis

“…21 Bao et al switched treatment with rhEPO to treatment with roxadustat for patients undergoing PD and found that their Hb levels increased by an average of 20.7 g/L compared with those before treatment; furthermore, their serum ferritin levels decreased at the beginning of treatment. 22 During this study, both groups experienced increased ferritin levels during infection, with a more significant increase observed in the roxadustat group. However, the recovery of ferritin levels after infection occurred faster in the roxadustat group, possibly because of hepcidin regulation.…”

“…Akizawa et al found that serum hepcidin levels decreased in patients undergoing PD who were treated with roxadustat, indicating an increase in iron absorption and utilization 21 . Bao et al switched treatment with rhEPO to treatment with roxadustat for patients undergoing PD and found that their Hb levels increased by an average of 20.7 g/L compared with those before treatment; furthermore, their serum ferritin levels decreased at the beginning of treatment 22 . During this study, both groups experienced increased ferritin levels during infection, with a more significant increase observed in the roxadustat group.…”

Exploring the impact of cognitive impairments on treatment compliance and quality of life in patients with Continuous Ambulatory Peritoneal Dialysis (CAPD)

“…Further analysis showed that the cognitive impairment group had lower compliance in all 4 dimensions compared to the normal cognition group (Table 3). There are many factors that can affect compliance, including age, diabetes history, residual kidney function, serum albumin, and high peritoneal transport status, [18][19][20] but there is relatively little research on the role of cognitive dysfunction in compliance. The results of this study showed that cognitive dysfunction may be an important factor in the low compliance of CAPD patients, indicating that targeted interventions for CAPD patients with cognitive dysfunction to improve compliance and prognosis are necessary.…”