Case Report
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Dec 16, 2022; 10(35): 13122-13128
Published online Dec 16, 2022. doi: 10.12998/wjcc.v10.i35.13122
Response to roxadustat in a patient undergoing long-term dialysis and allergic to erythropoiesis-stimulating agents: A case report
Cai Xu, Deng-Gui Luo, Zhe-Yan Liu, Dong Yang, Dan-Dan Wang, Yuan-Zhao Xu, Jun Yang, Bo Fu, Ai-Rong Qi
Cai Xu, Deng-Gui Luo, Zhe-Yan Liu, Dong Yang, Yuan-Zhao Xu, Jun Yang, Bo Fu, Ai-Rong Qi, Department of Nephrology, The Fourth Affiliated Hospital of Guangzhou University of Chinese Medicine, Shenzhen 518000, Guangdong Province, China
Dan-Dan Wang, Department of Nephrology, Shenzhen Traditional Chinese Medicine Hospital, Shenzhen 518000, Guangdong Province, China
Author contributions: Xu C and Luo DG contributed equally to this work; all authors have read and approve the final manuscript.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: All the authors declare that they have no conflict of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Ai-Rong Qi, PhD, Chief Physician, Department of Nephrology, The Fourth Affiliated Hospital of Guangzhou University of Chinese Medicine, No. 1 Fuhua Road, Futian District, Shenzhen 518000, Guangdong Province, China. 81863418@163.com
Received: October 11, 2022
Peer-review started: October 11, 2022
First decision: November 2, 2022
Revised: November 10, 2022
Accepted: November 24, 2022
Article in press: November 24, 2022
Published online: December 16, 2022
Abstract
BACKGROUND

Hypoxia-inducible factor prolyl hydroxylase inhibitor is a new class of drugs for treating renal anemia. It is a second-generation hypoxia-inducible factor prolyl hydroxylase-2 (PHD2) inhibitor. Roxadustat can effectively increase hemoglobin in patients with dialysis-dependent chronic kidney disease, with an adverse events profile comparable to that of epoetin alfa. We administered roxadustat to a maintenance hemodialysis patient who was allergic to erythropoiesis-stimulating agents (ESAs) and depended on blood transfusion for five years. After applying Roxadustat, the patient’s anemia improved significantly.

CASE SUMMARY

A 77-year-old Chinese man had type 2 diabetes for 16 years, underwent maintenance hemodialysis for five years, and had fatigue for five years. Laboratory tests showed severe anemia (hemoglobin concentration of 42 g/L). The patient was administered a subcutaneous injection of ESAs before dialysis. He suffered an allergic shock immediately and fainted. His blood pressure dropped to undetectable levels. He was not administered ESAs henceforth. The patient was prescribed iron supplements and received blood transfusions occasionally for five years. His hemoglobin concentration ranged from 42-68 g/L. After taking six weeks of oral roxadustat three times weekly (100 mg TIW), the patient’s hemoglobin concentration increased significantly, and his symptoms decreased. We adjusted the doses of roxadustat, and the hemoglobin concentration was maintained between 97 and 126 g/L.

CONCLUSION

Oral roxadustat is effective in treating anemia in maintenance hemodialysis patients who cannot be administered ESAs.

Keywords: Chronic kidney disease, Hemodialysis, Anemia, Roxadustat, Erythropoiesis- stimulating agents, Allergic shock, Case report

Core Tip: Anemia of dialysis-dependent chronic kidney disease is commonly treated with erythropoiesis-stimulating agents (ESAs), along with iron supplementation; however, in some cases, patients cannot be administered erythropoiesis-stimulating agents. Roxadustat is a newly developed drug for renal anemia treatment. It is an oral hypoxia-inducible factor-prolyl hydroxylase inhibitor that stimulates erythropoiesis and regulates iron metabolism. In this study, we presented a case in which Roxadustat was administered for the treatment of a patient allergic to ESAs. This was the first case where roxadustat was administered to improve anemia in a patient allergic to ESAs and on maintenance hemodialysis.