Associations of roxadustat with copper elevation and hypothyroidism in patients on hemodialysis

This study aimed to assess the associations of roxadustat with changes in serum trace element levels and with hypothyroidism in hemodialysis (HD) patients.

A total of 34 patients on HD who received weekly doses of darbepoetin-α or a continuous erythropoietin receptor activator once every 2 or 4 weeks were switched to roxadustat (70 mg, three times weekly). Levels of biomarkers for erythropoiesis and iron metabolism, trace elements (copper, zinc, and selenium), ceruloplasmin, and thyroid-stimulating hormone (TSH), free-triiodothyronine (T3), and free-tetraiodothyronine (T4) were measured in blood samples collected before the HD session on days 0 (switch to roxadustat treatment), 28, and 56.

Serum copper and ceruloplasmin levels were significantly increased by roxadustat treatment on days 28 and 56, and serum selenium levels were lower on day 28. However, serum zinc levels were not changed over the 56 days. Serum TSH levels were decreased on day 28, and they then increased to baseline on day 56. Serum free-T3 and free-T4 levels were significantly decreased from day 28 to day 56. Changes in roxadustat doses were associated with changes in serum TSH, free-T3, and free-T4 levels, whereas they were not associated with serum levels of trace elements.

Roxadustat may decrease serum TSH, free-T3, and free-T4 levels and increase serum copper and ceruloplasmin levels in HD patients.