Roxadustat as treatment for a blood transfusion-dependent maintenance hemodialysis patient:A case report and review of literature

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.

Role of minimally invasive techniques in gastrointestinal surgery:Current status and future perspectives

In recent years,the incidence of gastrointestinal cancer has remained high.Currently,surgical resection is still the most effective method for treating gastrointestinal cancer.Traditionally,radical surgery depends on open surgery.However,traditional open surgery inflicts great trauma and is associated with a slow recovery.Minimally invasive surgery,which aims to reduce postoperative complications and accelerate postoperative recovery,has been rapidly developed in the last two decades;it is increasingly used in the field of gastrointestinal surgery and widely used in early-stage gastrointestinal cancer.Nevertheless,many operations for gastrointestinal cancer treatment are still performed by open surgery.One reason for this may be the challenges of minimally invasive technology,especially when operating in narrow spaces,such as within the pelvis or near the upper edge of the pancreas.Moreover,some of the current literature has questioned oncologic outcomes after minimally invasive surgery for gastrointestinal cancer.Overall,the current evidence suggests that minimally invasive techniques are safe and feasible in gastrointestinal cancer surgery,but most of the studies published in this field are retrospective studies and casematched studies.Large-scale randomized prospective studies are needed to further support the application of minimally invasive surgery.In this review,we summarize several common minimally invasive methods used to treat gastrointestinal cancer and discuss the advances in the minimally invasive treatment of gastrointestinal cancer in detail.

Prognostic value of red cell distribution width in elderly patients undergoing maintenance hemodialysis

Objective:To investigate the predictive value of red blood cell distribution width(RDW)for all-cause mortality in elderly patients undergoing maintenance hemodialysis(MHD).Methods:We retrospectively analyzed the data of 172 elderly patients who initiated maintenance hemodialysis from June 2013 to June 2018.Basic data on demographic,dialysis,laboratory data and clinic outcomes were recorded.Compare the basic information of death and survival groups,such as general characteristics baseline laboratory data,baseline RDW and time average RDW during the follow-up;Cox regression analysis was used to analyze the risk factors of all-cause mortality,and predictive value of RDW for all-cause death in elderly maintenance hemodialysis patients.Results:A total of 172 elderly MHD patients were inrolled in this study with age of(66.3±6.1)years old and the dialysis duration of(27.3±15.3)months,including 94 males(54.6%).37 patients died during the follow-up period.Non-survivors had higher levels of RDW at baseline,higher time-average RDW,higher blood PTH,higher blood C-reactive protein(CRP),higher blood brain natriuretic peptide(BNP)(P<0.05)and lower albumin(P<0.05).Multivariate Cox regression analysis suggested that RDW,serum albumin,serum CRP,and serum BNP were independent risk factors for all-cause mortality in elderly patients with MHD.The receiver operating characteristic curve(ROC)showed that RDW=14.75%was the best cut-off point for predicting all-cause mortality in elderly patients undergoing MHD(P<0.01).Conclusions:High RDW is an independent risk factor for all-cause mortality in elderly patients with MHD,and it has important value for prognosis.