Roxadustat for Refractory Anemia Associated to Cytomegalovirus Infection in Kidney Transplantation

Area of Science:

• Nephrology
• Hematology
• Transplantation Immunology

Background:

• Anemia is a frequent post-kidney transplant (KT) complication, often exacerbated by cytomegalovirus (CMV) infection.
• CMV infection can worsen anemia by increasing hepcidin and inhibiting HIF-2α, leading to erythropoiesis resistance.
• Roxadustat, a hypoxia-inducible factor prolyl hydroxylase inhibitor (HIF-PHI), is a potential treatment for anemia resistant to erythropoiesis-stimulating agents (ESAs).

Purpose of the Study:

• To report the successful use of roxadustat in two kidney transplant recipients with ESA-refractory anemia and concurrent CMV infection.
• To evaluate the efficacy and safety of roxadustat in this specific patient population.

Main Methods:

• Retrospective case report of two kidney transplant recipients with anemia and CMV infection.
• Treatment with roxadustat initiated due to ESA resistance.
• Monitoring of hemoglobin levels, renal function, and adverse events.

Main Results:

• Both patients experienced significant hemoglobin recovery within one month of roxadustat treatment.
• Roxadustat administration led to sustained hemoglobin levels with dose adjustments in one case.
• No adverse effects or decline in renal function were observed during the follow-up period.

Conclusions:

• Roxadustat appears to be a safe and effective option for managing anemia in kidney transplant patients with CMV infection and ESA resistance.
• The drug may improve anemia by stimulating erythropoietin, reducing hepcidin, and enhancing iron utilization.
• Further prospective studies are warranted to confirm the safety and efficacy of roxadustat in this population.