Objective  To compare the clinical efficacy and safety of roxadustat and erythropoietin (EPO) in the treatment of patients with maintenance dialysis renal anemia.

Methods  A prospective cohort study was conducted to collect patients with maintenance dialysis renal anemia with or without chronic heart failure who were treated with roxadustat or EPO in the nephrology department of Nantong First People's Hospital from December 2020 to December 2021. The levels of hemoglobin (Hb) and serum ferritin (SF) in patients with renal anemia after 1 month, 3 months and 6 months of treatment with roxadustat or EPO, and the adverse reactions of cardiovascular system in patients in 6 months of treatment were compared.

Results  A total of 142 patients were included, including 75 patients in the roxadustat group and 67 patients in the EPO group. There was no significant difference between two groups in age, sex, weight, dialysis mode and duration, previous EPO dosage, Hb level, SF level, transferrin saturation (TSAT), cardiac function grading and blood pressure level at baseline (P>0.05). After 1 month, 3 months, and 6 months of treatment, the levels of Hb of both groups increased compared to the baseline period (P<0.05). Compared with the EPO group, the level of Hb in the roxadustat group was significantly higher after 1 month of treatment (P<0.05), and there was no significant difference between two groups after 3 or 6 months of treatment (P>0.05). There was no significant difference in SF level and the incidence of adverse reactions of cardio-cerebrovascular system between two groups (P>0.05).

Conclusion  Roxadustat has obvious advantages in the initial treatment stage compared with EPO, which can rapidly increase the Hb level. The cardiovascular safety of roxadustat is equivalent to EPO.

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