The Effects of Roxadustat on Thyroid Hormone Levels in Chinese Patients Undergoing Maintenance Hemodialysis

Background Recent studies have indicated that patients with chronic kidney disease (CKD) experience central hypothyroidism (CH) following treatment with roxadustat. Our objective is to assess the effect of roxadustat on the hypothalamic-pituitary-thyroid (HPT) axis in patients undergoing maintenance hemodialysis (MHD) and to explore whether it may cause potential tissue toxicity. Methods A total of 140 patients undergoing MHD were enrolled in this cross-sectional study. Thyroid hormones, including thyroid stimulating hormone (TSH), free triiodothyronine (FT3), and free thyroxine (FT4), as well as parameters of lipid metabolism, cardiac function, and bone metabolism, were assessed. The patients were divided into two groups based on their roxadustat treatment status: the roxadustat group (n = 53) and the control group (n = 87), differences between groups were evaluated using the Student’s t-test or the Mann-Whitney U test. Unconditional logistic regression analysis was utilized to identify risk factors for hypothyroidism. Results The roxadustat group demonstrated lower serum levels of TSH, FT3, and FT4 compared to the control group. Additionally, four cases (7.5%) exhibited abnormalities in all three indicators, and seven cases had TSH levels below 0.4 mU/L. Notably, none of the patients exhibited clinical symptoms of hypothyroidism. Unconditional logistic regression analysis indicated that roxadustat was an independent risk factor for hypothyroidism, with an odds ratio (95% confidence interval) of 3.635 (1.593, 8.291). Furthermore, the roxadustat group had lower levels of serum total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), and N-terminal pro-B-type natriuretic peptide (NT-proBNP), and higher levels of serum total procollagen type I N-terminal propeptide (TPINP). Conclusions Roxadustat is an independent risk factor for hypothyroidism; however, no adverse off-target effects on organs were observed.