Effect Of Hypoxia-inducible Factor Prolyl Hydroxylase Inhibitors On Anemia And Iron Metabolism In Patients With Chronic Renal Failure And Thalassemia

Objective: To observe the clinical effect of hypoxia-inducible factor prolyl hydroxylase inhibitors(Roxadustat capsules)in patients with chronic renal failure and thalassemia,and to analyze the characteristics of changes in iron metabolism indicators.Method:This study was a randomized controlled study.A total of 86 patients with chronic renal failure with thalassemia admitted to the Second Affiliated Hospital of Hainan Medical University from August 2020 to August 2022 were selected as the study objects.These patients were randomly divided into r Hu EPO group and Roxadustat group.The r Hu EPO group was treated with recombinant human erythropoietin.Roxadustat group was treated with Roxadustat capsule.After 12 weeks of treatment,the anemia indexes of 4 weeks,8 weeks and 12 weeks of comparing the two groups included: red blood cell count(RBC),hemoglobin(HB),hematocrit(HCT),iron metabolism indexes included: total iron binding capacity(TIBC),serum iron(SI),ferritin(SF),transferrin(Tf),transferrin saturation(TSAT),and the inflammatory indexes before and after treatment of the two groups included white blood cell number(WBC),hypersensitivity C-reactive protein(hs-CRP),Erythrocyte sedimentation rate(ESR)and recording the occurrence of adverse effects.Statistical methods of student’s T test and repeated measure analysis of variance were used for analysis.Results:The general baseline clinical data and clinical laboratory indicators before treatment were not statistically significant between the two groups(P<0.05).RBC,Hb and HCT of both groups were increased at 4 weeks,8 weeks and 12 weeks,and showed an increasing trend with the treatment time(P<0.05),and the increase range of Roxadustat group was larger than r Hu EPO group(P<0.05).In the Roxadustat group,TIBC,SI,Tf and TSAT were increased at 4 weeks,8 weeks and 12 weeks,and increased with the treatment time(P<0.05),while SF showed a decreasing trend(P<0.05).In the r Hu EPO group,SF,Tf and TSAT at 4 weeks,8 weeks and 12 weeks had no significant changes with the treatment time(P>0.05).The TIBC and SI levels at 4 weeks and 8 weeks in r Hu EPO group were not significantly different from those before treatment(P>0.05),but the TIBC and SI levels at 12 weeks were higher than those before treatment(P<0.05).Compared with the two groups,with the extension of treatment time,the increased levels of TIBC,SI,Tf and TSAT in Roxadustat group were significantly higher than those in r Hu EPO group(P<0.05),and the decreased range of SF in Roxadustat group was significantly higher than that in r Hu EPO group(P<0.05).hs-CRP and ESR in the Roxadustat group at 12 weeks were significantly decreased compared with those before treatment(P < 0.05);hs-CRP and ESR in r Hu EPO group were not significantly different before and after treatment(P>0.05).The incidence of total adverse reactions in Roxadustat group was significantly lower than that in r Hu EPO group(P<0.05).Conclusion : Chronic renal failure patients with thalassemia generally have iron utilization impairment.Roxadustat can effectively improve hemoglobin,iron utilization and inflammation in patients with chronic renal failure and thalassemia.The efficacy of Roxadustat was better than r Hu EPO,and the overall incidence of adverse reactions was lower than r Hu EPO.