Risk Factors for Bleeding and Thromboembolic Events in Patients With Chronic Kidney Disease on Maintenance Hemodialysis: A Retrospective Case-Control Study Based on the Roxadustat User Population.

Abstract

Background: Chronic kidney disease (CKD) often necessitates maintenance hemodialysis, a process associated with significant complications such as bleeding and thromboembolic events. Roxadustat, a hypoxia-inducible factor prolyl hydroxylase inhibitor, is emerging as a promising alternative for managing anemia in CKD. This study aims to assess risk factors for bleeding and thromboembolic events in CKD patients on hemodialysis, focusing on Roxadustat use.

Methods: We conducted a retrospective case-control study of 229 CKD patients undergoing maintenance hemodialysis for at least 1 year. Patients were categorized based on the occurrence of bleeding (n = 51) or thromboembolic events (n = 58), compared to those without such events (n = 120). Baseline demographics, laboratory markers, and Roxadustat usage were evaluated. Logistic regression analyses were used to identify independent risk factors for bleeding and thromboembolic events.

Results: Roxadustat usage was significantly less common in patients who experienced bleeding events (64.71%) compared to the no occurrence group (85.00%, p = 0.003), and similarly less common in those with thromboembolic events (67.24%) compared to the no occurrence group (85.00%, p = 0.006). Lower baseline hemoglobin levels were associated with bleeding events (p = 0.007), while higher baseline hemoglobin levels were associated with thromboembolic events (p = 0.008). Elevated baseline hs-CRP levels were significant in both the bleeding group (p = 0.001) and thromboembolic group (p = 0.019). TSAT below 30% at baseline was also a significant factor in both the bleeding group (p = 0.004) and thromboembolic group (p = 0.025). Multivariate analyses indicated that Roxadustat use significantly reduced bleeding risk (OR = 0.376, p = 0.024) and thromboembolic events (OR = 0.287, p = 0.003).

Conclusion: Roxadustat use was associated with a lower risk of bleeding and thromboembolic events in CKD patients on hemodialysis. This association may be mediated through the stabilization of hemoglobin levels, modulation of iron metabolism, and attenuation of inflammation.