Abstract
Renal anemia has been identified as an important independent risk factor for left ventricular hypertrophy and progression of heart failure, as well as adverse cardiovascular outcomes. Recent studies suggest that hypoxia-inducible factor prolyl hydroxylase inhibitors (HIF-PHIs) Roxadustat may represent a novel pharmacological treatment for renal anemia. This study aimed to compare the role of Roxadustat and erythropoietin in reversing ventricular remodeling in dialysis patients with anemia. This was a retrospective cohort study compared the treatment of Roxadustat and erythropoietin in dialysis patients for at least 24 weeks from January 2016 to August 2021. A total of 181 participants underwent echocardiography at least twice every 6 months. Baseline and follow-up examinations focused on the change of cardiac structure and function (doppler echocardiography), clinical and biochemical parameters and blood pressure. Participants were treated with oral iron supplements and angiotensin-converting enzyme inhibitors or angiotensin receptor blockers and controlled blood pressure (target value≤130 / 80 mmHg). There were no significant difference in age, sex and body mass index between two groups. However, left ventricular mass index (LVMI) and LV end diastolic dimension (LVDd) significantly decreased from 137.81±36.88 to 129.79±35.33 g/m2 (P=0.003), and from 5.19±0.68 to 5.02±0.69 cm (P=0.001) in Roxadustat-treated dialysis patients, respectively. In addition, Roxadustat increased hemoglobin and serum albumin level and reduced the level of diastolic blood pressure, low density lipoprotein, and lipoprotein(a). Interestingly, there was no obvious effect on LVMI or any other parameters of LV remodeling in erythropoietin-treated dialysis patients although the level of hemoglobin and serum albumin was increased and lipoprotein(a) level was decreased. In addition to the efficacy in the treatment of renal anemia, Roxadustat was found to be closely associated with improvement of LV diastolic function in dialysis patients. Our findings may provide new insights into anemia management in dialysis patients. Prospective clinical trials are necessary to further evaluate the role of Roxadustat or other HIF-PHIs in reversing ventricular remodeling.
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