Objective To investigate the efficacy of roxadustat combined with iron supplements in treating renal anemia in maintenance dialysis patients and its effects on the proline hydroxylase 2 (PHD2)/hypoxia-inducible factor (HIF)-2α pathway. Methods A total of 111 patients with renal anemia undergoing maintenance dialysis at Dazhou Dachuan District People’s Hospital from June 2021 to June 2023 were selected and divided into three groups using the random number table method. Control group 1 received roxadustat alone, control group 2 received iron supplements alone, and the combined group received roxadustat plus iron supplements. Anemia symptoms, hematological parameters, iron metabolism indices, PHD2/HIF-2α pathway markers, and adverse reactions were compared across the three groups. Results The total effective rate of the combined group was higher than that of the control group 1 (χ2=5.046, P=0.025) and the control group 2 (χ2=14.131, P＜0.001). Post-treatment scores for pallor, dizziness, chest tightness, and memory decline in the combined group were significantly lower than those in control groups 1 and 2 (F=52.085, 81.722, 81.208, 111.818; all P＜0.001). The combined group also showed higher post-treatment hemoglobin (Hb), hematocrit (Hct), red blood cell count (RBC), ferritin, transferrin, transferrin saturation (TSAT), and total iron-binding capacity (TIBC) compared to both control groups (F=44.763, 70.279, 37.997, 64.326, 24.704, 48.965, 52.505; all P＜0.001). Conversely, unsaturated iron-binding capacity (UIBC), PHD2, HIF-1α, and HIF-2α levels were significantly lower in the combined group (F=49.801, 39.901, 62.073, 51.449; all P＜0.001). Conclusion Roxadustat combined with iron therapy effectively improves anemia symptoms, hematological parameters, and iron metabolism in maintenance dialysis patients with renal anemia, potentially through modulation of the PHD2/HIF-2α pathway.
ZHAO Jian-Ping
. The efficacy of roxadustat combined with iron therapy in treating renal anemia in maintenance dialysis patients and its impact on the proline hydroxylase 2/hypoxia-inducible factor-2 α pathway[J]. Chinese Journal of Blood Purification, 2025
, 24(06)
: 463
-468
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DOI: 10.3969/j.issn.1671-4091.2025.06.005
[1] Zheng L,Tian JH,Liu DP,et al.Efficacy and safety of roxadustat for anaemia in dialysis-dependent and non-dialysis-dependent chronic kidney disease patients:A systematic review and meta-analysis[J].Br J Clin Pharmacol,2022,88(3):919-932.doi:10.1111/bcp.15055.
[2] Ichii M,Mori K,Miyaoka D,et al.Suppression of thyrotropin secretion during roxadustat treatment for renal anemia in a patient undergoing hemodialysis[J].BMC Nephrol,2021,22(1):104.doi:10.1186/s12882-021-02304-2.
[3] 程红娟,魏芝薇,史慧,等.罗沙司他治疗维持性血液透析患者难治性肾性贫血的疗效观察[J].实用临床医药杂志,2021,25(14):75-77,83.DOI:10.7619/jcmp.20211178.
[4] Thévenod F,Schreiber T,Lee WK.Renal hypoxia-HIF-PHD-EPO signaling in transition metal nephrotoxicity:friend or foe[J].Arch Toxicol,2022,96(6):1573-1607.doi:10.1007/s00204-022-03285-3.
[5] Provenzano R,Shutov E,Eremeeva L,et al.Roxadustat for anemia in patients with end-stage renal disease incident to dialysis[J].Nephrol Dial Transplant,2021,36(9):1717-1730.doi:10.1093/ndt/gfab051.
[6] 中华医学会肾脏病学分会肾性贫血诊断和治疗共识专家组.肾性贫血诊断与治疗中国专家共识(2018修订版)[J].中华肾脏病杂志,2018,34(11):860-866.DOI:10.3760/cma.j.issn.1001-7097.2018.11.012.
[7] 刘璐,许岭,王允吉,等.生血宁片结合罗沙司他治疗肾性贫血临床疗效研究[J].中华中医药学刊,2022,40(09):247-250.DOI:10.13193/j.issn.1673-7717.2022.09.054.
[8] Chuasuwan A,Pooripussarakul S,Thakkinstian A,et al.Comparisons of quality of life between patients underwent peritoneal dialysis and hemodialysis:a systematic review and meta-analysis[J].Health Qual Life Outcomes,2020,18(1):191.doi:10.1186/s12955-020-01449-2.
[9] 吕晴,陈卫东,刘磊.维持性血液透析患者肾性贫血的多因素分析及相关性研究[J].中华全科医学,2021,19(5):871-874.DOI:10.16766/j.cnki.issn.1674-4152.001938.
[10] Liao RX,Zhou XL,Ma DY,et al.Iron Deficiency is Associated With Platelet Count Elevation in Patients With Dialysis-dependent Chronic Kidney Disease[J].J Ren Nutr,2022,32(5):587-594.doi:10.1053/j.jrn.2021.09.004.
[11] 薛渊.高血清铁蛋白合并低转铁蛋白饱和度肾性贫血患者铁剂治疗的临床疗效分析[J].安徽医药,2015,(10):2024-2025.DOI:10.3969/j.issn.1009-6469.2015.10.061.
[12] 汪丽丽,孙娴静,张馨怡,等.罗沙司他联合蔗糖铁和促红细胞生成素治疗血液透析患者肾性贫血疗效观察[J].新乡医学院学报,2021,38(9):818-821,827.DOI:10.7683/xxyxyxb.2021.09.004.
[13] 王莉丽,侯儆,杨蔓玲,等.罗沙司他联合琥珀酸亚铁治疗维持性血液透析肾性贫血患者的疗效分析[J].中国医刊,2023,58(8):844-848.DOI:10.3969/j.issn.1008-1070.2023.08.010.
[14] Coyne DW,Roger SD,Shin SK,et al.Roxadustat for CKD-related Anemia in Non-dialysis Patients[J].Kidney Int Rep,2020,6(3):624-635.doi:10.1016/j.ekir.2020.11.034.
[15] Hou YP,Mao XY,Wang C,et al.Roxadustat treatment for anemia in peritoneal dialysis patients:A randomized controlled trial[J].J Formos Med Assoc,2022,121(2):529-538.doi:10.1016/j.jfma.2021.06.004.
[16] Fishbane S,Pollock CA,El-Shahawy M,et al.Roxadustat Versus Epoetin Alfa for Treating Anemia in Patients with Chronic Kidney Disease on Dialysis: Results from the Randomized Phase 3 ROCKIES Study[J].J Am Soc Nephrol,2022,33(4):850-866.doi:10.1681/ASN.2020111638.
[17] Ogawa C,Tsuchiya K,Maeda K.Hypoxia-Inducible Factor Prolyl Hydroxylase Inhibitors and Iron Metabolism[J].Int J Mol Sci,2023,24(3):3037.doi:10.3390/ijms24033037.
[18] Zheng QY,Yang HS,Fu XW,et al.The efficacy and safety of roxadustat for anemia in patients with chronic kidney disease:a meta-analysis[J].Nephrol Dial Transplant.,2021,36(9):1603-1615.doi:10.1093/ndt/gfaa110.
[19] Zuk A,Si Z,Loi S,et al.Preclinical Characterization of Vadadustat (AKB-6548), an Oral Small Molecule Hypoxia-Inducible Factor Prolyl-4-Hydroxylase Inhibitor, for the Potential Treatment of Renal Anemia[J].J Pharmacol Exp Ther,2022,383(1):11-24.doi:10.1124/jpet.122.001126.
[20] Ozurumba E,Mathew O,Ranganna K,et al.Regulation of hypoxia inducible factor/prolyl hydroxylase binding domain proteins 1 by PPARα and high salt diet[J].J Basic Clin Physiol Pharmacol,2018,29(2):165-173.doi:10.1515/jbcpp-2017-0074.
[21] Sato T,Takeda N.The roles of HIF-1α signaling in cardiovascular diseases[J].J Cardiol,2023,81(2):202-208.doi:10.1016/j.jjcc.2022.09.002.
[22] 傅奕,石春珍,李鑫,等.罗沙司他治疗初始血液透析患者肾性贫血临床疗效评价[J].中国血液净化,2022,21(7):483-486.DOI:10.3969/j.issn.1671-4091.2022.07.005.
[23] Requena-Ibá?ez JA,Santos-Gallego CG,Rodriguez-Cordero A,et al.Prolyl Hydroxylase Inhibitors:a New Opportunity in Renal and Myocardial Protection[J].Cardiovasc Drugs Ther,2022,36(6):1187-1196.doi:10.1007/s10557-021-07257-0.
