Department of Nephrology, The Second Affiliated Hospital of Xuzhou Medical University, Xuzhou, China.
Department of Nephrology, Beijing Aerospace General Hospital, Beijing, China.
Korean J Intern Med. 2023 Mar;38(2):147-156. doi: 10.3904/kjim.2022.318. Epub 2023 Jan 2.
The incidence of chronic kidney disease (CKD) is increasing worldwide and the current prevalence rate is 13.4%. There are > 120 million CKD patients in China and this number is expected to increase. One of the main abnormalities in patients with CKD and kidney impairment is decreased synthesis of erythropoietin (EPO), which causes anemia and affects iron metabolism. The probability of developing is higher in anemia patients with CKD than in the general population, and the incidence increases as kidney function decreases. Deficient EPO production by the kidney is the most important cause of renal anemia. Notably, anemia in patients with CKD has multiple causes, such as bleeding caused by platelet dysfunction, iron deficiency due to digestive and absorption disorders of the gastrointestinal tract, and shorter red blood cell life. Anemia is also a leading cause of hospitalization in patients with CKD. A new oral medication to treat renal anemia, the hypoxia-inducible factor prolyl hydroxylase inhibitor called roxadustat (FG-4592), regulates iron metabolism and promotes erythropoiesis. This drug has a therapeutic effect on patients with CKD. Roxadustat showed advantages over EPO in clinical experiments. This review summarizes the mechanisms of action, clinical applications, effectiveness, and safety of roxadustat.
慢性肾脏病（CKD）的发病率在全球范围内呈上升趋势，目前的患病率为 13.4%。中国有超过 1.2 亿 CKD 患者，且这一数字预计还会增加。CKD 和肾功能损害患者的主要异常之一是促红细胞生成素（EPO）合成减少，这会导致贫血并影响铁代谢。与普通人群相比，CKD 贫血患者发生这种情况的概率更高，而且随着肾功能的下降，发病率会增加。肾脏产生的 EPO 不足是导致肾性贫血的最重要原因。值得注意的是，CKD 患者的贫血有多种原因，如血小板功能障碍导致的出血、胃肠道消化吸收紊乱导致的缺铁以及红细胞寿命缩短。贫血也是 CKD 患者住院的主要原因之一。一种治疗肾性贫血的新型口服药物，缺氧诱导因子脯氨酰羟化酶抑制剂罗沙司他（FG-4592），可调节铁代谢并促进红细胞生成。该药对 CKD 患者具有治疗作用。罗沙司他在临床试验中优于 EPO。本综述总结了罗沙司他的作用机制、临床应用、疗效和安全性。
