Roxadustat as treatment for a blood transfusion-dependent maintenance hemodialysis patient: A case report and review of literature

Abstract

Background: Erythropoiesis-stimulating agents (ESAs) have revolutionized the therapeutic strategy for anemia in chronic kidney disease. However, some cases are resistant or hyporesponsive to ESAs. Roxadustat is an oral hypoxia-inducible factor-prolyl hydroxylase inhibitor that stimulates erythropoiesis and regulates iron metabolism. Here, we describe a hemodialysis patient with refractory anemia who did not respond to traditional treatments and depended on blood transfusion for more than 1 year. After applying Roxadustat, the patient's anemia improved significantly.

Case summary: A 44-year-old man was diagnosed with uremia accompanied by severe anemia with a hemoglobin (Hb) level ranging from 30-40 g/L. His anemia did not improve after sufficient dialysis or high doses of active ESAs; other causes of anemia were excluded. The patient required approximately 600-1000 mL of red blood cell suspension every 15-30 d for more than 1 year. After accepting Roxadustat therapy, the patient's anemia symptoms improved significantly; his Hb level gradually increased to 50 g/L, and no further blood transfusions were administered. His Hb level reached 69 g/L by the 34^th week. Although a Hb level of 60-70 g/L cannot be considered satisfactory, he no longer required blood transfusions and his quality of life was substantially improved. Roxadustat showed good efficacy and safety in this case.

Conclusion: Roxadustat represents an innovative and effective agent for the clinical treatment of renal anemia caused by multiple complex factors.

Keywords: Case report; Chronic kidney disease; Erythropoiesis-stimulating agent resistance; Erythropoiesis-stimulating agents; Renal anemia; Roxadustat.

Figure 1

Changes in hemoglobin and reticulocyte count after oral administration of Roxadustat. Hb: Hemoglobin; RET: Reticulocyte.

Figure 2

Changes in blood lipids after oral administration of Roxadustat. HDL-C: High-density lipoprotein cholesterol; LDL-C: Low-density lipoprotein cholesterol; TC: Total cholesterol; TG: Triglyceride.

Figure 3

Changes in C-reactive protein after oral administration of Roxadustat. Arrow at week 16, C-reactive protein was significantly elevated in the patient because of concurrent respiratory infections. CRP: C-reactive protein.