Association of Roxadustat Versus Erythropoiesis-Stimulating Agents With Renal Outcomes in Non-Dialysis CKD: A...

To evaluate the association between roxadustat use and renal outcomes, compared with erythropoiesis-stimulating agents (ESAs), in patients with non-dialysis-dependent chronic kidney disease (CKD) and anemia.

This retrospective cohort study included patients with CKD and anemia treated at Ruijin Hospital between January 2010 and December 2022 who had an estimated glomerular filtration rate (eGFR) ≥15 mL/min/1.73 m² at baseline. Patients treated with roxadustat were compared with those treated with ESAs. Propensity score matching was used to balance baseline characteristics between groups. The composite renal endpoint was defined as a ≥ 50% decline in eGFR, doubling of serum creatinine, or progression to end-stage kidney disease. Annual eGFR slopes were compared, and Cox proportional hazards models were used to assess the association between treatment and the composite renal endpoint.

After propensity score matching, 852 patients were included, with 426 in each group; more than 90% had stage 3-4 CKD. In the overall matched cohort, the annual decline in eGFR did not differ significantly between the roxadustat and ESAs groups. Among patients aged > 60 years, the median eGFR slopes were -1.84 and -3.50 mL/min/1.73 m²/yr in the roxadustat and ESAs groups, respectively (P = 0.02), whereas no significant difference was observed among those aged ≤ 60 years. In multivariable Cox models, exploratory analyses suggested possible effect modification by age (P for interaction = 0.03). The overall incidence of adverse events was comparable between groups (27.93% vs 29.34%; P = 0.65).

Among patients with non-dialysis-dependent CKD and anemia, roxadustat and ESAs were associated with similar renal outcomes overall. Subgroup findings suggest possible heterogeneity in treatment effects by age. Further studies are warranted to clarify the clinical relevance of these findings.