Yu Wei-Hong, Li Xie-Jia, Yuan Fang
Department of Nephrology, The Second Xiangya Hospital of Central South University, Changsha 410011, Hunan Province, China.
World J Clin Cases. 2020 Dec 6;8(23):6048-6055. doi: 10.12998/wjcc.v8.i23.6048.
Hyporesponsiveness to erythropoiesis-stimulating agents (ESAs) is a prevalent problem in patients with chronic kidney disease. It is associated with increased morbidity and mortality in patients who undergo dialysis. A significant proportion of patients do not respond to iron supplementation and conventional ESAs. We report a case of severe ESA hyporesponsiveness-related anemia that was successfully treated with oral roxadustat.
A 59-year-old Chinese woman had high blood glucose for 25 years, maintenance hemodialysis for 7 years, and recurrent dizziness and fatigue for more than 2 years. Laboratory tests showed severe anemia (hemoglobin level of 54 g/L), though bone marrow biopsy, fluorescence hybridization, and hemolysis tests were within normal ranges. We initially administered first-line therapies and other adjuvant treatments, such as blood transfusions, ESAs, and adequate dialysis, but the patient did not respond as anticipated. Her erythropoietin-resistant anemia was probably not only due to chronic renal insufficiency. The patient received the hypoxia-inducible factor prolyl hydroxylase inhibitor roxadustat (100 mg, three times weekly). After 12 wk of treatment, the patient's hemoglobin increased significantly, and her symptoms were alleviated. During the follow-up period, adverse drug reactions were controllable and tolerable.
Oral roxadustat is effective and tolerable for the treatment of ESA hypores-ponsiveness-related anemia in patients undergoing hemodialysis.
对促红细胞生成素（ESA）反应低下是慢性肾脏病患者中普遍存在的问题。它与接受透析患者的发病率和死亡率增加有关。相当一部分患者对铁补充剂和传统ESA无反应。我们报告一例严重的与ESA反应低下相关的贫血病例，该病例经口服罗沙司他成功治疗。
一名59岁中国女性，有25年高血糖病史，维持性血液透析7年，反复头晕、乏力2年余。实验室检查显示严重贫血（血红蛋白水平为54g/L），尽管骨髓活检、荧光杂交和溶血试验均在正常范围内。我们最初给予一线治疗及其他辅助治疗，如输血、ESA和充分透析，但患者未出现预期反应。她的促红细胞生成素抵抗性贫血可能不仅归因于慢性肾功能不全。该患者接受了缺氧诱导因子脯氨酰羟化酶抑制剂罗沙司他（100mg，每周3次）治疗。治疗12周后，患者血红蛋白显著升高，症状缓解。在随访期间，药物不良反应可控且可耐受。
口服罗沙司他治疗血液透析患者中与ESA反应低下相关的贫血有效且耐受性良好。
