Roxadustat for renal anemia: current clinical experience

Area of Science:

• Nephrology
• Pharmacology
• Biochemistry

Background:

• Anemia is a common complication of chronic kidney disease (CKD).
• Oxygen-sensing mechanisms, targeted by hypoxia-inducible factor prolyl hydroxylase inhibitors (HIF-PHIs), regulate erythropoietin production.
• Roxadustat, the first HIF-PHI, was approved in China in 2018 for CKD anemia.

Purpose of the Study:

• To review clinical insights and real-world experience with roxadustat, a first-in-class HIF-PHI.
• To explore the effects of HIF activation beyond erythropoiesis and iron metabolism.
• To provide a framework for the clinical application of other HIF-PHIs.

Main Methods:

• Systematic review of clinical data and real-world evidence for roxadustat.
• Synthesis of information on HIF activation's pleiotropic effects.
• Analysis of therapeutic applications and outstanding clinical questions.

Main Results:

• Roxadustat is superior to placebo and non-inferior to erythropoiesis-stimulating agents for hemoglobin management in CKD patients (dialysis and non-dialysis).
• Substantial real-world experience confirms roxadustat's therapeutic application.
• HIF activation likely influences processes beyond erythropoiesis and iron metabolism.

Conclusions:

• Roxadustat demonstrates efficacy in treating anemia across CKD patient populations.
• Understanding the broader effects of HIF activation is crucial for optimizing therapeutic strategies.
• This review provides evidence for the clinical use of roxadustat and other HIF-PHIs.