Li Nan, Cui Wenxia, Mu Dinghuang, Shi Xiaoting, Gao Lei, Liu Sixiu, Wang Hengjin, Jiang Chunming, Hu Yun
Department of Nephrology, Nanjing Drum Tower Hospital, Drum Tower Clinical College of Nanjing Medical University, Nanjing, China.
Department of Nephrology, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China.
Int J Med Sci. 2024 Jul 9;21(10):1806-1813. doi: 10.7150/ijms.97599. eCollection 2024.
Roxadustat is commonly used to treat renal anemia. However, the potential effects of roxadustat on metabolism and organs other than the kidneys have recently attracted increased attention. This study aimed to examine the regulatory effects of roxadustat on thyroid hormones and blood lipid metabolism in patients with end-stage kidney disease (ESKD) undergoing hemodialysis. Eighty ESKD patients on hemodialysis and taking roxadustat were enrolled. Hemoglobin, thyroid hormones (TSH, FT3, FT4), and blood lipid profiles (TC, LDL-C, TG, HDL-C) were assessed before and after treatment. Changes in these parameters were compared, and relevant causative factors were analyzed. Roxadustat significantly increased Hb, lowered TSH, FT4, TC, and LDL-C levels (all P<0.001). Patients were categorized into three groups based on post-treatment TSH inhibition percentage: Q1(≥70%), Q2(30%-70%), Q3(≤30%). Pre-treatment TSH decreased with reduced TSH inhibition (P<0.05). Post-treatment, TC, LDL-C, TSH, FT3, and FT4 increased with reduced TSH inhibition (all P<0.05).TC and LDL-C significantly decreased post-treatment in Q1 and Q2 (P<0.05). Correlation analysis showed a positive correlation between ΔTSH and pre-treatment TSH levels (r=0.732, P<0.001). The proportion of patients with ≥70% TSH inhibition increased with higher pre-treatment TSH levels (P for trend <0.05). ΔLDL-C and ΔTSH were positively correlated (r=0.278, P<0.05), with ΔTSH identified as an influencing factor in multiple linear regression (β=0.133, 95% CI [0.042, 0.223], P<0.05). Roxadustat effectively improves anemia in ESKD patients while inhibiting TSH and FT4 secretion and reducing TC and LDL-C levels. Decreases in TSH levels correlate with baseline TSH levels, and lowered blood lipid levels are associated with decreased TSH levels.
罗沙司他常用于治疗肾性贫血。然而，罗沙司他对代谢及肾脏以外器官的潜在影响最近受到了更多关注。本研究旨在探讨罗沙司他对接受血液透析的终末期肾病（ESKD）患者甲状腺激素和血脂代谢的调节作用。纳入80例接受血液透析且正在服用罗沙司他的ESKD患者。在治疗前后评估血红蛋白、甲状腺激素（促甲状腺激素[TSH]、游离三碘甲状腺原氨酸[FT3]、游离甲状腺素[FT4]）和血脂谱（总胆固醇[TC]、低密度脂蛋白胆固醇[LDL-C]、甘油三酯[TG]、高密度脂蛋白胆固醇[HDL-C]）。比较这些参数的变化，并分析相关的致病因素。罗沙司他显著提高了血红蛋白水平，降低了TSH、FT4、TC和LDL-C水平（均P<0.001）。根据治疗后TSH抑制百分比将患者分为三组：Q1（≥70%）、Q2（30%-70%）、Q3（≤30%）。治疗前TSH随着TSH抑制率降低而下降（P<0.05）。治疗后，TC、LDL-C、TSH、FT3和FT4随着TSH抑制率降低而升高（均P<0.05）。Q1组和Q2组治疗后TC和LDL-C显著降低（P<0.05）。相关性分析显示，TSH变化量（ΔTSH）与治疗前TSH水平呈正相关（r=0.732，P<0.001）。TSH抑制率≥70%的患者比例随着治疗前TSH水平升高而增加（趋势P<0.05）。ΔLDL-C与ΔTSH呈正相关（r=0.278，P<0.05），在多元线性回归中ΔTSH被确定为一个影响因素（β=0.133，95%置信区间[0.042，0.223]，P<0.05）。罗沙司他可有效改善ESKD患者的贫血，同时抑制TSH和FT4分泌并降低TC和LDL-C水平。TSH水平的降低与基线TSH水平相关，血脂水平的降低与TSH水平降低有关。
