Case Report
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. May 26, 2021; 9(15): 3680-3688
Published online May 26, 2021. doi: 10.12998/wjcc.v9.i15.3680
Roxadustat as treatment for a blood transfusion-dependent maintenance hemodialysis patient: A case report and review of literature
Min Fei, Xiang-Qiong Wen, Zhao-Lan Yu, Ting Kang, Wei-Hua Wu, San-Tao Ou
Min Fei, Xiang-Qiong Wen, Zhao-Lan Yu, Ting Kang, Wei-Hua Wu, San-Tao Ou, Department of Nephrology, The Affiliated Hospital of Southwest Medical University, Luzhou 646000, Sichuan Province, China
Min Fei, Xiang-Qiong Wen, Zhao-Lan Yu, Ting Kang, Wei-Hua Wu, San-Tao Ou, Sichuan Clinical Research Center for Nephropathy, Luzhou 646000, Sichuan Province, China
Author contributions: Ou ST and Wen XQ treated the patient; Yu ZL followed up with the patient and collected the clinical data; Wu WH analyzed and interpreted the clinical data; Fei M wrote the first draft; Kang T and Fei M wrote the final draft; All authors read and approved the final manuscript.
Supported by Sichuan Clinical Research Center for Nephropathy, No. 2019YFS0537-3.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflicts of interest.
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: San-Tao Ou, MD, PhD, Chief Doctor, Professor, Department of Nephrology, The Affiliated Hospital of Southwest Medical University, No. 25 Taiping Street, Luzhou 646000, Sichuan Province, China. ousantao@163.com
Received: December 21, 2020
Peer-review started: December 21, 2020
First decision: January 17, 2021
Revised: January 25, 2021
Accepted: March 15, 2021
Article in press: March 15, 2021
Published online: May 26, 2021
Processing time: 140 Days and 19.6 Hours
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 34th 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: Chronic kidney disease; Renal anemia; Erythropoiesis-stimulating agents; Erythropoiesis-stimulating agent resistance; Roxadustat; Case report

Core Tip: Anemia is a common complication of chronic kidney disease, often in combination with increased morbidity and mortality. Treatment of anemia in advanced chronic kidney disease includes iron replacement and administration of erythropoiesis-stimulating agents (ESAs). However, anemia remains undertreated because of concerns of the safety of ESAs. Roxadustat is an oral hypoxia-inducible factor-prolyl hydroxylase inhibitor (HIF-PHI) that stimulates erythropoiesis and regulates iron metabolism. We present a case in which Roxadustat was used for the treatment of a blood transfusion-dependent maintenance hemodialysis patient. This case highlights that increasing HIF activity with small-molecule HIF-PHIs such as Roxadustat is an innovative therapeutic approach for anemia.