Zhao Bing, Yang Xiaowei, Li Weidan, Zhu Huizi, Meng Qian, Ma Yongjian, Liu Yun, Zhou Yan, Lin Jiangong, Zhai Chunjuan, Zhao Lian, Sun Jing, Wang Rong
Department of Nephrology, Shandong Provincial Hospital affiliated to Shandong First Medical University, Jinan, Shandong, China.
Institute of Health Service and Transfusion Medicine, Academy of Military Medical Sciences, Academy of Military Science of the Chinese People's Liberation Army, Beijing, China.
Clin Kidney J. 2023 Apr 10;16(9):1500-1507. doi: 10.1093/ckj/sfad080. eCollection 2023 Sep.
Reduced survival of red blood cells (RBCs) in patients with chronic kidney disease (CKD) is thought to contribute to renal anaemia. Although renal anaemia improved greatly because of the wide use of erythropoiesis-stimulating agents (ESAs) and the advancement of dialysis techniques, RBC longevity seems not to be obviously ameliorated.
In this single-centre, single-arm trial, patients who had been undergoing haemodialysis and ESA therapy with epoetin alfa for at least 12 weeks changed their anti-anaemia drugs from epoetin alfa to oral roxadustat three times per week for 24 weeks. The primary endpoint was the change in RBC lifespan from baseline at week 24. The change in the circulating percentage of eryptotic RBCs, RBC deformability and RBC oxygen transport ability were also assessed.
A total of 27 patients were enrolled, with 26 completing the full course of intervention. At baseline, the average RBC lifespan was 60.1 days [standard deviation (SD) 14.4; = 27]. At the end of the study period, 26 patients had an RBC lifespan measurement (83.9 days on average; SD 21.9). The RBC lifespan increased by 22.8 days on average [95% confidence interval (CI) 15.5-30.0, < .001]. This equated to an average RBC lifespan increase of 39.2% (95% CI 27.8-50.6). The percentage of circulating eryptotic RBCs, erythrocyte filtration index and the pressure at which haemoglobin is 50% saturated decreased significantly from baseline to week 24 (1.39 ± 0.44% versus 0.89 ± 0.25%, < .0001; 0.29 ± 0.12 versus 0.16 ± 0.08, < .0001 and 32.54 ± 4.83 versus 28.40 ± 2.29, < .001, respectively).
Roxadustat prolonged RBC lifespan in patients with long-term haemodialysis.
慢性肾脏病（CKD）患者红细胞（RBC）生存期缩短被认为是导致肾性贫血的原因之一。尽管由于促红细胞生成素（ESAs）的广泛应用和透析技术的进步，肾性贫血有了很大改善，但红细胞寿命似乎并未明显改善。
在这项单中心、单臂试验中，接受血液透析且使用重组人促红素α进行ESA治疗至少12周的患者，将抗贫血药物从重组人促红素α改为口服罗沙司他，每周三次，共24周。主要终点是第24周时红细胞寿命相对于基线的变化。还评估了凋亡红细胞循环百分比、红细胞变形性和红细胞氧运输能力的变化。
共纳入27例患者，26例完成了全程干预。基线时，平均红细胞寿命为60.1天[标准差（SD）14.4；n = 27]。在研究期结束时，对26例患者进行了红细胞寿命测量（平均83.9天；SD 21.9）。红细胞寿命平均增加了22.8天[95%置信区间（CI）15.5 - 30.0，P <.001]。这相当于红细胞寿命平均增加了39.2%（95% CI 27.8 - 50.6）。从基线到第24周，循环凋亡红细胞百分比、红细胞滤过指数以及血红蛋白饱和度为50%时的压力均显著降低（分别为1.39 ± 0.44%对0.89 ± 0.25%，P <.0001；0.29 ± 0.12对0.16 ± 0.08，P <.0001；32.54 ± 4.83对28.40 ± 2.29，P <.001）。
罗沙司他可延长长期血液透析患者的红细胞寿命。
