Peridialytic Erythropoietin vs. Roxadustat in Hemodialysis-Dependent Patients with CKD

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Background: Erythropoietin and roxadustat are commonly used to manage anemia in hemodialysis-dependent chronic kidney disease (CKD) patients, but the comparative safety and effectiveness are unknown Methods: Patients with CKD stage G5 and anemia (hemoglobin <100 g/L) who were treated with either erythropoietin or roxadustat were included. The primary endpoints included expanded composite of major adverse cardiovascular events (MACE+), in the peridialytic period, defined as the duration from the time of estimated glomerular filtration rate (eGFR) decrease to <15 mL/minto 3 months after dialysis initiation. A propensity score-matched analysis (1:1 ratio; caliper width: 0.02) was conducted to minimize the impact of confounding factors. Results: 1092 were included in the propensity score-matched analysis (546 in each group). In comparison to the roxadustat group, the erythropoietin group had a lower rate of MACE+ events within 6 months (13.4% vs. 21.2%; P<0.001) and 12 months of treatment initiation (17.0% vs. 24.0%; P=0.004), as well as within 3 months of hemodialysis initiation (12.9% vs. 28.7%; P<0.001). The rate of cardiocerebrovascular events was also lower in the erythropoietin group within 6 months (38.5% vs. 50.7%, P<0.001) and 12 months of treatment initiation (49.1% vs. 56.2%, P<0.001). Conclusion: Peridialytic erythropoietin was associated with a more favorable cardiovascular safety profile versus roxadustat in hemodialysis-dependent CKD patients. Proportions of patients with hospitalization for complications and length of hospital stay - Characteristic Erythropoietin Roxadustat P# Within 6 months of treatment initiation, n (%) 310 (56.8) 383 (70.1) <0.001 Length of hospital stay, days* 23.8±21.6 (10.0, 31.0) 24.5±23.2 (12.0, 29.0) 0.471 Within 12 months of treatment initiation, n (%) 358 (65.6) 412 (75.5) <0.001 Length of hospital stay, days* 27.5±26.4 (11.0, 35.0) 28.3±29.1 (13.0, 34.0) 0.372 Within 3 months of hemodialysis initiation, n(%) 284 (52.0) 326 (59.7) 0.010 Length of hospital stay, days* 20.1±13.9 (11.0, 27.0) 23.2±15.5 (12.5, 30.0) 0.014

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