Discussion
CKD, cancer, acidosis, anemia, PD, Inflammation, hyperkalemia, peritonitis, metabolic acidosis
CANCER, ACIDOSIS, ANEMIA, IRON DEFICIENCY, INFLAMMATION, PERITONITIS, METABOLIC ACIDOSIS, CHRONIC INFLAMMATION
In this 24-week clinical study of PD patients, roxadustat significantly reduced the rise of sTFR and reduced the occurrence of functional iron deficiency by lowering hepcidin levels, although there was no significant difference in the incidence of absolute iron deficiency between the two groups. In addition, roxadustat improved anemia and lipid metabolism without increasing the incidence of hyperkalemia, metabolic acidosis, and peritonitis.Since there were 22% of patients who had insufficient iron reserve state the number. The roxadustat group still had significantly improved iron metabolism levels in PD patients, with a smaller proportion of oral iron patients. We suggest that the decreased hepcidin levels and increased iron availability associated with roxadustat may have contributed to these findings [Clinically, TSAT (an index of iron utilization state) < 20% and sFt (an index of iron storage state) < 100 ng/mL is diagnosed as absolute iron deficiency in PD patients. Functional iron deficiency is characterized by TSAT < 20% and normal or elevated sFt levels [Because roxadustat mediates the transition from aerobic to anaerobic metabolism, the immediate consequence of increased glycolysis is tissue acidification and lactic acid overproduction. The acidosis reaction leads to the release of potassium ions from cells, resulting in hyperkalemia [CKD patients often suffer from chronic inflammation due to excessive production and retention of urinary toxins, abnormal intestinal flora, and changes in the integrity of intestinal barrier. Inflammation blocks the output and absorption of iron that bacteria need to survive by stimulating the expression of hepcidin [It should be noted that this study has the following limitations: first of all, this trial is a single-center study, and these participants may not be generalizable to other populations. Secondly, we believe that the use of diuretics and bicarbonate supplements reduced the incidence of hyperkalemia and metabolic acidosis in roxadustat group, but we regret that the use of drug was not counted during the study. Finally, this study only studied the changes in patients’ condition after 24 weeks of treatment, which may not be long enough to observe the safety of roxadustat. The risks of angiogenesis and cancer associated with HIF have been demonstrated, and further studies are needed before firm conclusions can be drawn.