Effect of oral iron on the ability of roxadustat to ameliorate anemia in peritoneal dialysis patients: A real-world 24-week study

Background Roxadustat is an orally bioavailable hypoxia-inducible factor prolyl hydroxylase inhibitor (HIF-PHI) that regulates iron metabolism in patients with chronic kidney disease (CKD) primarily by reducing hepcidin levels and mobilizing internal iron stores. With increased iron utilization, iron deficiency may occur in some patients, and more data are needed to evaluate the exogenous iron requirements of peritoneal dialysis (PD) patients receiving roxadustat to treat anemia. Methods We performed a prospective cohort study of anemic (Hb ≤ 100.0 g/L) patients undergoing PD. One hundred six patients received no iron or oral iron while they were treated with roxadustat for 24 weeks. The primary endpoints included Hb compliance rates, changes in iron biomarker levels and the proportion of patients with absolute iron deficiency and functional iron deficiency. Results Compared with no iron supplementation, oral iron supplementation significantly increased Hb levels (difference, 10.20 g/L; 95% CI, 1.93 to 18.48) and Hb compliance rates (oral iron, 70.97%; no iron, 51.28%); attenuated the increase in serum soluble transferrin receptor (sTFR) levels (difference, -5.66 nmol/L; 95% CI, -10.30 to -1.02) and sTFR/logsFt levels (difference, -0.32; 95% CI, -0.54 to -0.11); and reduced the proportion of patients with absolute iron deficiency (oral iron, 16.13%; no iron, 28.21%). Hepcidin levels decreased significantly from baseline in both groups, by 23.94% in PD patients receiving no iron (n = 39) and by 23.33% in PD patients receiving oral iron (n = 31). Conclusions Compared with no iron supplementation, oral iron supplementation can significantly reduce the incidence of absolute iron deficiency and significantly improve the efficacy of roxadustat in the treatment of anemia in PD patients. These results suggest that adequate iron supplementation is necessary during roxadustat therapy. Trial registration : This study was registered on the Chinese Clinical Trial Registry on March 4, 2022 (registration number: ChiCTR2200057231).