单中心腹膜透析患者应用罗沙司他治疗肾性贫血22例疗效观察

Effect of Roxadustat treatment for renal anemia in 22 cases of patients undergoing peritoneal dialysis in a single center

目的了解腹膜透析患者口服罗沙司他治疗肾性贫血的有效性和安全性,评估其对于患者临床指标的影响。方法纳入2019年9月至2020年7月于杭州医学院附属浙江省人民医院腹透中心规律腹膜透析的患者共22例为研究对象,接受口服罗沙司他胶囊治疗,血红蛋白目标为100~120 g/L,治疗时间为6个月,停药后继续随访3个月,如血红蛋白低于110 g/L则接受重组人促红素注射液治疗,研究期间停用静脉铁剂治疗。结果17例患者完成了罗沙司他6个月的疗程及后续3个月随访,基线血红蛋白水平为(102±9)g/L,达标率为70.6%,服用罗沙司他后的3个月、6个月血红蛋白水平分别为(119±10)g/L、(116±11)g/L,平均血红蛋白达标率为94.1%,罗沙司他停药后应用人促红素注射液治疗的3个月平均血红蛋白达标率为66.7%。基线时患者总胆固醇水平中位数为4.1 mmol/L,3个月时总胆固醇水平中位数为3.7 mmol/L,6个月时为3.9 mmol/L,均较基线时明显下降(P<0.05)。3个月铁蛋白及转铁蛋白饱和度较基线下降(128.5μg/L vs.184.0μg/L,22.3%vs.26.6%),6个月及9个月与基线相比差异无统计学意义,血清铁水平基线时中位数为15.0μmol/L,3个月、6个月及9个月中位数分别为13.3μmol/L、16.8μmol/L、14.8μmol/L,均较基线时差异无统计学意义。结论腹膜透析患者口服罗沙司他治疗贫血可有效提高血红蛋白达标率,耐受性好。

Objective To investigate the efficacy and safety of oral Roxadustat in the treatment of renal anemia in peritoneal dialysis(PD)patients and to evaluate its effect on clinical indicators.Methods Totally 22 patients were recruited in PD center of Zhejiang Provincial People's Hospital,from September 2019 to July 2020.Patients received oral Roxadustat three times a week and the hemoglobin target was 100-120 g/L.After treatment for 6 months,patients whose hemoglobin were less than 110 g/L would receive erythropoiesis stimulating agents(ESA)injection.Intravenous iron therapy was not allowed during all the study period.Results Totally 17 patients completed 6 months of treatment and 3 months of follow-up.The baseline hemoglobin level was(102±9)g/L and the compliance rate was 70.6%.Hemoglobin at 3 months and 6 months was(119±10)g/L and(116±11)g/L respectively.The average hemoglobin compliance rate was 94.1%.The mean haemoglobin compliance rate was 66.7%in 3 months after switching over to human erythropoietin injection.The median total cholesterol level was 4.1 mmol/L at baseline.The median total cholesterol level was 3.7 mmol/L at 3 months,and 3.9 mmol/L at 6 months.They were all significantly lower than that at baseline(P<0.05).Ferritin and transferrin saturation decreased at 3 months compared with baseline(128.5μg/L vs.184.0μg/L,22.3%vs.26.6%),and there were no significant difference between baseline and at 6 months or 9 months.The median serum iron level at baseline was 15.0μmol/L,which 13.3μmol/L at 3 months,16.8μmol/L at 6 months and 14.8μmol/L at 9 months respectively.Serum iron level remained stable.Conclusion Roxadustat is well tolerated and effective in maintaining target Hb levels in patients on PD.