Sex-Specific Impact of Roxadustat on Residual Kidney Function in Peritoneal Dialysis Patients: A Propensity...

Roxadustat effectively improves renal anemia, but its impact on residual kidney function (RKF) preservation in continuous ambulatory peritoneal dialysis (CAPD) patients is unclear. Our objective was to evaluate the impact of roxadustat on RKF decline in prevalent CAPD patients, with particular emphasis on identifying sex-specific differential outcomes.

Retrospective cohort study.

This study included 360 CAPD patients treated with either roxadustat (n=144) or erythropoiesis-stimulating agents (ESAs) (n=216) at our center between January 2021 and June 2024.

CAPD patients diagnosed with renal anemia were treated with roxadustat or ESAs to achieve target hemoglobin levels.

The primary endpoint was the decline in RKF during the 18-month follow-up period, measured by the average of 24-hour urinary urea and creatinine clearances adjusted for the body surface area (mL/min/1.73 m²). Secondary endpoints included changes in hemoglobin levels and lipid profiles, as well as the incidence of peritonitis.

Propensity scores methods, including 1:1 propensity score matching with replacement and inverse probability of treatment weighting.

Overall, neither propensity score matching nor inverse probability of treatment weighting models showed significant difference in RKF preservation between the roxadustat and ESA groups. However, in male patients, roxadustat was associated with a slower decline in RKF compared with ESAs (Δ-0.8 vs Δ-1.4 mL/min/1.73 m²; P = 0.04) at 18 months. Additionally, hemoglobin levels were comparable between groups. The roxadustat group exhibited lower triglycerides and low-density lipoprotein level than the ESA group. No significant difference in peritonitis incidence was observed between the 2 groups.

The overall baseline RKF of our PD patients was exceptionally low.

Roxadustat delays RKF decline in male CAPD patients while providing comparable anemia control and favorable lipid profile effects as ESAs. These sex-specific outcomes suggest underlying biological mechanisms, highlighting the need for larger, targeted studies to further elucidate the potential benefits of roxadustat in this population.