Case Report
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Dec 6, 2020; 8(23): 6048-6055
Published online Dec 6, 2020. doi: 10.12998/wjcc.v8.i23.6048
Roxadustat for treatment of erythropoietin-hyporesponsive anemia in a hemodialysis patient: A case report
Wei-Hong Yu, Xie-Jia Li, Fang Yuan
Wei-Hong Yu, Xie-Jia Li, Fang Yuan, Department of Nephrology, The Second Xiangya Hospital of Central South University, Changsha 410011, Hunan Province, China
Author contributions: Yuan F designed the study; Li XJ and Yu WH collected the patient’s clinical data and contributed to drafting the manuscript; and all authors issued final approval for this version to be submitted.
Supported by the National Natural Science Foundation of China, No. 81770730; and the Hunan Provincial Natural Science Fund, No. 2017JJ2352.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report.
Conflict-of-interest statement: The authors declare that they have no conflicts of interest to disclose.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Fang Yuan, MD, PhD, Chief Doctor, Department of Nephrology, The Second Xiangya Hospital of Central South University, No. 139 Renmin Road, Changsha 410011, Hunan Province, China. yuanfang@csu.edu.cn
Received: May 28, 2020
Peer-review started: May 28, 2020
First decision: September 13, 2020
Revised: September 26, 2020
Accepted: October 19, 2020
Article in press: October 19, 2020
Published online: December 6, 2020
Processing time: 189 Days and 19.2 Hours
Abstract
BACKGROUND

Hyporesponsiveness to erythropoiesis-stimulating agents (ESAs) is a prevalent problem in patients with chronic kidney disease. It is associated with increased morbidity and mortality in patients who undergo dialysis. A significant proportion of patients do not respond to iron supplementation and conventional ESAs. We report a case of severe ESA hyporesponsiveness-related anemia that was successfully treated with oral roxadustat.

CASE SUMMARY

A 59-year-old Chinese woman had high blood glucose for 25 years, maintenance hemodialysis for 7 years, and recurrent dizziness and fatigue for more than 2 years. Laboratory tests showed severe anemia (hemoglobin level of 54 g/L), though bone marrow biopsy, fluorescence in situ hybridization, and hemolysis tests were within normal ranges. We initially administered first-line therapies and other adjuvant treatments, such as blood transfusions, ESAs, and adequate dialysis, but the patient did not respond as anticipated. Her erythropoietin-resistant anemia was probably not only due to chronic renal insufficiency. The patient received the hypoxia-inducible factor prolyl hydroxylase inhibitor roxadustat (100 mg, three times weekly). After 12 wk of treatment, the patient’s hemoglobin increased significantly, and her symptoms were alleviated. During the follow-up period, adverse drug reactions were controllable and tolerable.

CONCLUSION

Oral roxadustat is effective and tolerable for the treatment of ESA hypores-ponsiveness-related anemia in patients undergoing hemodialysis.

Keywords: Renal anemia; Erythropoietin hyporesponsiveness; Hepcidin; Interleukin 6; Roxadustat; Case report

Core Tip: We present a case of refractory erythropoiesis-stimulating agent hyporesponsiveness-related anemia in which oral roxadustat increased and maintained hemoglobin. Roxadustat may be a useful optional treatment for anemia in patients with chronic kidney disease. Future clinical trials are needed to assess potential problems with hypoxia-inducible factor prolyl hydroxylase inhibitors.