Ting Yang

Introduction: The efficacy of oral roxadustat in dialysis patients with renal anemia and overt infections remains uncertain.Objectives: In this retrospective cohort study, 2816 such patients were screened, of whom 167 were enrolled and assigned to either roxadustat (n = 88) or recombinant human EPO (rHuEPO; n = 79) for treatment.Methods and results: Baseline hemoglobin levels were 90.3 ± 15.2 g/L and 91.9 ± 17.8 g/L, respectively. All patients received a mean of 10.6 ± 3.3 days of infection treatment. Types of infection included pulmonary, peritoneal dialysis-associated peritonitis, catheterrelated, urinary tract, and others. Compared with rHuEPO, roxadustat led to significantly greater increases in hemoglobin and ΔHb, and more pronounced improvements in ferritin, transferrin saturation (TSAT), and hepcidin levels following infection. The analysis demonstrated that TSAT, hepcidin, dialysis modality, residual renal function, infection type, and PCT levels play critical roles in mediating the efficacy of roxadustat under active infection conditions. Among peritoneal dialysis patients, roxadustat was associated with significantly greater improvements in ΔHb, ferritin, and TSAT compared to rHuEPO. ΔHb values varied by infection type, with significantly higher increases in peritoneal dialysis-associated peritonitis and a trend toward larger ΔHb in other infections relative to those in pulmonary infections. Based on procalcitonin levels, more severe infections were correlated with lower ΔHb values.Conclusion: Overal, roxadustat was more effective than rHuEPO in ameliorating renal anemia in infected dialysis patients.

Introduction: Hydroxychloroquine (HCQ) is recommended for Chinese patients with immunoglobulin A nephropathy (IgAN). This study aimed to investigate the pharmacokinetics of HCQ in the treatment of IgAN and its relationship with therapeutic efficacy. Methods: This prospective study included 49 IgAN patients treated with HCQ, who were divided into effective and ineffective groups based on HCQ treatment efficacy after 6 months, defined as a reduction in proteinuria of at least 50% from baseline. The concentrations of HCQ and its metabolites were measured by high-performance liquid chromatography-tandem mass spectrometry. The relationships between the concentrations of HCQ and its metabolites and therapeutic efficacy were analyzed using linear correlation analysis and logistic regression. Receiver operating characteristic (ROC) curves were generated to evaluate the predictive value of HCQ and its metabolite concentrations. Results: Following 6 months of treatment with HCQ, patients in the effective group exhibited increased concentrations of HCQ (p = 0.022) and desethylchloroquine (DCQ) (p = 0.015). The results of the Spearman’s correlation analysis indicated a positive correlation between alterations in proteinuria and concentrations of HCQ (r = 0.328, p < 0.05) and DCQ (r = 0.267, p < 0.05). Univariate and multivariate logistic regression analyses indicated that efficacy was significantly correlated with HCQ (odds ratio 1.008, 95% CI: 1.001–1.014) and DCQ (odds ratio 1.064, 95% CI: 1.010–1.121) concentrations. ROC curves indicated that an HCQ concentration of 442.6 ng/mL and a DCQ concentration of 42.7 ng/mL exhibited the optimal capacity to predict efficacy (p < 0.05). Conclusion: The blood concentrations of HCQ and its metabolite DCQ may be significant factors for evaluating therapeutic efficacy in IgAN patients.