Effect Of Roxadustat On The Erythroferrone-hepcidin Axis In Patients With Mhd Renal Anemia

Objective:To study the changes in serum levels of Erythroferrone（ERFE）,hepcidin（Hep）,iron metabolism,lipid metabolism and other clinically relevant indicators in maintenance hemodialysis（MHD）patients with renal anemia after treatment with Roxadustat And the relationship between them.Methods:Sixty patients with maintenance hemodialysis（MHD）with renal anemia were divided into Roxadustat group（n=30）and erythropoiesis stimulating agents（ESAs）group（n=30）according to treatment methods.Roxadustat group was given100 mg（45～60 kg）or 120 mg（≥60 kg）oral starting dose,3 times a week,and the dosage was adjusted according to the level of hemoglobin（HGB）every month;In the ESAs group,intravenous injection of recombinant human erythrotropin(100 IU·kg^-1per week)was continued according to body weight,Adjust the dose monthly according to HGB change;Both groups were treated with iron supplementation according to their iron metabolism status,so that the HGB level reached and maintained at 100～120 g·L^-1;At the same time,the general clinical data such as age,gender,primary disease,C-reactive protein（CRP）,liver and kidney function of the patient were collected,The HGB,ERFE,hepcidin,iron metabolism and lipid metabolism indexes of the two groups before treatment and after 3 months and 6 months of treatment were tested,and the changes of various indexes within group and between groups were compared,and correlation analysis was performed.Results:1 There was no significant difference in the general data and baseline levels of various indicators between the Roxadustat group and the ESAs group（P>0.05）.After 3 and 6 months of treatment,the level of HGB in the two groups was higher than the baseline level,the level of HGB in the Roxadustat group was significantly higher than that in the ESAs group（P<0.05）.After 3 and 6 months of treatment,the levels of serum iron,Transferrin and Total iron binding capacity in the Roxadustat group were higher than those in the baseline（especially after 6 months）,and were significantly higher than those in the ESAs group,which difference was statistically significant（P<0.05）.There was no significant difference in the levels of Serum ferritin and Transferrin Saturation between the two groups before and after treatment（P>0.05）.After 3 and 6 months of treatment,the levels of Total cholesterol and Low density lipoprotein in the Roxadustat group decreased compared with the baseline,and the levels of TC and LDL decreased more significantly after 6 months of treatment,and were significantly lower than those in the ESAs group（P<0.05）.There was no significant difference in the levels of Triglyceride and high-density lipoprotein between the two groups before and after treatment（P>0.05）.After 3 and 6 months of treatment,the level of ERFE in the Roxadustat group was higher than that in the baseline level（especially after 6 months）,and was significantly higher than that in the ESAs group（P<0.05）.After 3and 6 months of treatment,the level of Hepcidin in the Roxadustat group was lower than that in the baseline level（especially after 6 months）,and was significantly lower than that in the ESAs group（P<0.05）.2 Multiple linear regression analysis showed that serum iron and ERFE were negatively correlated with iron-modulin as the dependent variable（standardized coefficient B was-0.37,-0.79,P value was 0.04,0.00）.With ERFE as the dependent variable,there was a significant negative correlation between ferromodulin and ERFE（normalization coefficient B was-0.82,P value was 0.00）.3 The levels of serum ERFE and Hepcidin were analyzed according to gender,diabetes and CRP levels in Roxadustat group.The results showed that there was no significant difference in serum ERFE and Hepcidin levels before treatment and 3 months and 6 months after treatment（P>0.05）.Conclusions:1 Roxadustat has a more significant effect on Renal anemia than ESAs,which can improve iron metabolism and iron utilization by increasing ERFE level and decreasing serum Hepcidin,and is not affected by inflammatory factors.2 There was a significant negative correlation between serum ERFE and Hepcidin,and which was not affected by inflammation,diabetes,sex and other factors.3 Roxadustat can reduce TC and LDL levels,and its regulation of lipid metabolism may be involved in ERFE.