Cheng Shuiqin, Zhou Tingting, Yu Le, Zhang Zhihong, Chen Yunmin, Zhang Man, Cui Jingjing, Yu Wenxin, Zhou Jian, Yu Yusheng
Department of Nephrology, National Clinical Research Center of Kidney Disease, Jinling Hosptial, Nanjing University School of Medicine, Nanjing, China.
Front Med (Lausanne). 2023 Jun 8;10:1166024. doi: 10.3389/fmed.2023.1166024. eCollection 2023.
Roxadustat treatment in PD patients is equivalent to ESAs in increasing hemoglobin (Hb). But blood pressure, cardiovascular parameters, cardio-cerebrovascular complications and prognosis in the two groups before and after treatment has not been sufficiently discussed.
Sixty PD patients who were treated with roxadustat for renal anemia in our PD center recruited from June 2019 to April 2020 as roxadustat group. PD patients treated with rHuEPO were enrolled at a 1:1 ratio as rHuEPO group using the method of propensity score matching. Hb, blood pressure, cardiovascular parameters, cardio-cerebrovascular complications and prognosis were compared between the two group. All patients were followed up for at least 24 months.
There were no significant differences in baseline clinical data or laboratory values between roxadustat group and rHuEPO group. After 24 months of follow-up, there was no significant difference in Hb levels (). There were no significant changes in blood pressure, or the incidence of nocturnal hypertension before and after treatment in roxadustat group (), while blood pressure significantly increased in rHuEPO group after treatment (). Compared with roxadustat group after follow-up, rHuEPO group had a higher incidence of hypertension, the levels of cardiovascular parameters were worse and cardio-cerebrovascular complications had a higher incidence (). Cox regression analysis showed age, systolic blood pressure, fasting blood glucose, and rHuEPO use before baseline were risk factors for cardio-cerebrovascular complications in PD patients, while treatment with roxadustat was a protective factor for cardiovascular and cerebrovascular complications.
Compared with rHuEPO, roxadustat had less influence on blood pressure or cardiovascular parameters, and it was associated with a lower risk of cardio-cerebrovascular complications in patients undergoing PD. Roxadustat has a cardio-cerebrovascular protective advantage in PD patients with renal anemia.
罗沙司他治疗帕金森病（PD）患者在提高血红蛋白（Hb）方面等同于促红细胞生成素（ESAs）。但两组治疗前后的血压、心血管参数、心脑血管并发症及预后情况尚未得到充分讨论。
2019年6月至2020年4月在我们的PD中心招募60例接受罗沙司他治疗肾性贫血的PD患者作为罗沙司他组。采用倾向评分匹配法，按1:1比例纳入接受重组人促红细胞生成素（rHuEPO）治疗的PD患者作为rHuEPO组。比较两组的Hb、血压、心血管参数、心脑血管并发症及预后情况。所有患者均随访至少24个月。
罗沙司他组与rHuEPO组的基线临床数据或实验室值无显著差异。随访24个月后，Hb水平无显著差异（）。罗沙司他组治疗前后血压及夜间高血压发生率无显著变化（），而rHuEPO组治疗后血压显著升高（）。随访后与罗沙司他组相比，rHuEPO组高血压发生率更高，心血管参数水平更差，心脑血管并发症发生率更高（）。Cox回归分析显示年龄、收缩压、空腹血糖及基线前使用rHuEPO是PD患者心脑血管并发症的危险因素，而罗沙司他治疗是心脑血管并发症的保护因素。
与rHuEPO相比，罗沙司他对血压或心血管参数影响较小，且与PD患者心脑血管并发症风险较低相关。罗沙司他在PD合并肾性贫血患者中具有心脑血管保护优势。
