Roxadustat for treatment of erythropoietin-hyporesponsive anemia in a hemodialysis patient: A case report

BACKGROUND: Hyporesponsiveness to erythropoiesis-stimulating agents (ESAs) is a prevalent problem in patients with chronic kidney disease. It is associated with increased morbidity and mortality in patients who undergo dialysis. A significant proportion of patients do not respond to iron supplementation and conventional ESAs. We report a case of severe ESA hyporesponsiveness-related anemia that was successfully treated with oral roxadustat. CASE SUMMARY: A 59-year-old Chinese woman had high blood glucose for 25 years, maintenance hemodialysis for 7 years, and recurrent dizziness and fatigue for more than 2 years. Laboratory tests showed severe anemia (hemoglobin level of 54 g/L), though bone marrow biopsy, fluorescence in situ hybridization, and hemolysis tests were within normal ranges. We initially administered first-line therapies and other adjuvant treatments, such as blood transfusions, ESAs, and adequate dialysis, but the patient did not respond as anticipated. Her erythropoietin-resistant anemia was probably not only due to chronic renal insufficiency. The patient received the hypoxia-inducible factor prolyl hydroxylase inhibitor roxadustat (100 mg, three times weekly). After 12 wk of treatment, the patient’s hemoglobin increased significantly, and her symptoms were alleviated. During the follow-up period, adverse drug reactions were controllable and tolerable. CONCLUSION: Oral roxadustat is effective and tolerable for the treatment of ESA hypores-ponsiveness-related anemia in patients undergoing hemodialysis.