Red blood cell lifespan in long-term hemodialysis patients treated with roxadustat or recombinant human erythropoietin

Introduction A significant decrease in red blood cell (RBC) survival has been observed in patients with renal failure, which is supposed to contribute to renal anemia. The aim of this observational study was to determine RBC survival in hemodialysis (HD) patients treated with roxadustat or recombinant human erythropoietin (rhuEPO) compared with healthy persons. Methods RBC lifespan was measured by Levitt's CO breath test with newly developed automatic instrument ELS Tester. Results A total of 102 patients receiving long-term HD from two independent dialysis centers enrolled in the study, of whom 62 were treated with rhuEPO and 40 were on roxadustat therapy. A total of 25 healthy participants were recruited to match HD participants according to age and sex. Median RBC survival times in rhuEPO, roxadustat, and control groups were 65.0 (25th-75th percentile, 49.5-77.3), 75.5 (25th-75th percentile, 57.3-99.3), and 108.0 (25th-75th percentile, 89.0-141.5) d, respectively. Patients treated with roxadustat had significantly longer RBC survival time than patients treated with rhuEPO (p < .05). In multivariate analysis of factors affecting RBC lifespan in the whole HD patients, anemia treatment drugs (rhuEPO/roxadustat) and levels of hemoglobin were the significantly independent factors. RBC survival was not found to correlate with either weekly rhuEPO dosage (r = -0.087, p = .500) or weekly roxadustat dosage (r = -0.267, p = .110) in our cohort. Conclusions HD patients treated with roxadustat had significantly longer RBC survival time than patients treated with rhuEPO, large prospective studies with long-term follow-up are warranted to verify the results in future.

Automated summary

Patients undergoing hemodialysis with roxadustat treatment had significantly longer red blood cell survival time compared to those treated with rhuEPO. Independent factors affecting RBC lifespan included anemia treatment drugs (rhuEPO/roxadustat) and hemoglobin levels.