Ganz Tomas, Locatelli Francesco, Arici Mustafa, Akizawa Tadao, Reusch Michael
Department of Medicine, University of California Los Angeles, Los Angeles, CA 90095, USA.
Department of Nephrology and Dialysis, Alessandro Manzoni Hospital, 23900 Lecco, Italy.
J Clin Med. 2023 Jun 22;12(13):4217. doi: 10.3390/jcm12134217.
Roxadustat is a novel agent with a distinct mechanism of action compared to erythropoiesis-stimulating agents (ESAs) and a potentially different combination of effects on iron parameters. This narrative review describes the effects of roxadustat on iron parameters and on hemoglobin levels in the context of iron supplementation in patients with anemia of non-dialysis-dependent (NDD) or dialysis-dependent (DD) chronic kidney disease (CKD). Roxadustat use was associated with a greater reduction in serum ferritin levels than seen with ESAs and an increase in serum iron levels compared to a decrease with ESAs. Decreases in transferrin saturation in patients treated with roxadustat were relatively small and, in the case of patients with NDD CKD, not observed by Week 52. These changes reflect the concomitant increases in both serum iron and total iron-binding capacity. Compared to placebo and an ESA, roxadustat improved iron availability and increased erythropoiesis while requiring less intravenous iron use. Hepcidin levels generally decreased in patients who received roxadustat compared to baseline values in all CKD populations; these decreases appear to be more robust with roxadustat than with an ESA or placebo. The mechanisms behind the effects of roxadustat and ESAs on iron availability and stores and erythropoiesis appear to differ and should be considered holistically when treating anemia of CKD.
罗沙司他是一种新型药物，与促红细胞生成素（ESA）相比，其作用机制独特，对铁参数的影响组合可能不同。本叙述性综述描述了在非透析依赖（NDD）或透析依赖（DD）的慢性肾脏病（CKD）患者补充铁的情况下，罗沙司他对铁参数和血红蛋白水平的影响。与ESA相比，使用罗沙司他可使血清铁蛋白水平降低得更多，与ESA使血清铁水平降低相反，罗沙司他可使血清铁水平升高。接受罗沙司他治疗的患者转铁蛋白饱和度下降相对较小，对于NDD CKD患者，在第52周时未观察到转铁蛋白饱和度下降。这些变化反映了血清铁和总铁结合力的同时增加。与安慰剂和ESA相比，罗沙司他改善了铁的可用性并增加了红细胞生成，同时减少了静脉铁的使用。与所有CKD人群的基线值相比，接受罗沙司他治疗的患者的铁调素水平通常会降低；与ESA或安慰剂相比，罗沙司他导致的铁调素水平降低似乎更明显。罗沙司他和ESA对铁可用性、储存和红细胞生成的影响背后的机制似乎不同，在治疗CKD贫血时应全面考虑。
