Roxarestat for treatment of erythropoietin (EPO)-induced pure red cell aplasia in a hemodialysis patient: a case report

Anemia is a prevalent complication in patients with chronic kidney disease (CKD), particularly those undergoing dialysis. Recombinant human erythropoietin (rhEPO) is widely administered to patients both on and off dialysis to manage this anemia. However, despite an initial favorable therapeutic response, a sudden and unexplained decline in hemoglobin levels (Hb) often prompts the need for further diagnostic evaluation. In this context, we report a clinical case involving a 48-year-old male patient who had been undergoing hemodialysis (HD) for two years. During the course of his rhEPO treatment regimen, he developed pure red cell aplasia (PRCA), a rare but serious adverse reaction. Upon recognition of this complication, the administration of rhEPO was promptly discontinued, and the patient was initiated on roxarestat therapy. Remarkably, following nine months of continuous roxarestat treatment, the patient experienced a significant and sustained increase in his Hb levels. This clinical outcome underscores the importance of prompt diagnosis and intervention in cases of EPO-induced PRCA. Furthermore, our findings suggest that roxarestat may serve as a viable and effective therapeutic option for patients with EPO-induced PRCA, potentially obviating the need for immunosuppressive therapy and its associated risks.