Explore the effect of HIF-PHI on blood pressure variation rate and anemia efficacy in maintenance hemodialysis patients.

Abstract

Objective: This study aims to investigate the impact of hypoxia-inducing factor prolyl hydroxylase inhibitor (HIF-PHI), specifically Roxadustat, on blood pressure variability, blood pressure indices, hemoglobin, and other biochemical markers in maintenance hemodialysis (MHD) patients.

Methods: In this retrospective, self-controlled study, regular hemodialysis and consistent use of Roxadustat for at least six months were conducted at the Hemodialysis Unit of the First Affiliated Hospital of Nanchang University between June 2019 and November 2022. The study involved MHD patients who had been using erythropoiesis-stimulating agents (ESAs) for at least six months prior to transitioning to Roxadustat. Blood pressure, routine blood data, biochemical parameters, and clinical data were collected before, during, and after dialysis over a 12-month period. Statistical comparisons were made of systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), and true variability in SBP (SBP-ARV), DBP (DBP-ARV), and MAP (MAP-ARV) in the patients before and after the transition to Roxadustat. Hemoglobin levels and daily antihypertensive drug dosage (DDD) were also analyzed.

Results: A total of 54 MHD patients (32 males and 22 females) were included in the study. Primary diagnoses included chronic nephritis, hypertensive nephropathy, diabetic nephropathy, obstructive nephropathy, polycystic kidney disease, nephrotic syndrome, scleroderma-related kidney injury, and cases of unknown etiology. Repeated measures variance analysis indicated that blood pressure fluctuations during Roxadustat treatment were significantly smaller than during ESA treatment. Statistically significant differences were observed in SBP, DBP, and MAP before and after dialysis (P-values: 0.046, < 0.001, 0.028, and 0.014, respectively). Paired t-tests revealed a significant reduction in SBP-ARV and MAP-ARV before and during dialysis in the Roxadustat group (P = 0.0018, 0.008, and 0.006). Hemoglobin, erythrocyte count, and serum calcium were significantly higher in the Roxadustat group compared to ESA treatment (P = 0.013, 0.012, and 0.003, respectively). In the high SBP variability group, a higher proportion of males, increased hospitalization rates, older age, and a higher prevalence of diabetes were observed.

Conclusion: MHD patients treated with Roxadustat experienced fewer fluctuations in blood pressure compared to those treated with rHuEPO, and Roxadustat was more effective at increasing hemoglobin levels without compromising efficacy relative to ESAs.

Clinical trial number: Not applicable.