Study drug administration
Patients in the roxadustat group were treated with roxadustat capsules [Enambojin (China) Pharmaceutical Technology Development Co., LTD., Sinopharm H20180024 (50 mg), H20180023 (20 mg)], administered three times a week at 70 mg (< 45 kg), 100 mg (45 to < 60 kg) or 120 mg (≥ 60 kg). The dose was adjusted according to a preset dosing ladder as follows: 20, 40, 50, 70, 100, 120, 150, and 200 mg. The maximum dose was 2.5 mg/kg. If the patient's hemoglobin increase was greater than 20 g/L within 2 weeks and the hemoglobin value was greater than 90 g/L, the dose was lowered by one step. Only one dose reduction over 4 weeks was recommended when hemoglobin rose too rapidly. Patients in the ESA group were treated with generic epoetin alpha [Sansheng Pharmaceutical Co., LTD., S19980073 (2000 IU), S19980074 (3000 IU), S19980072 (4000 IU), S20010001 (10000 IU)] at 75–100 IU/kg/week. The maximum dose of each adjustment was 30 IU/kg/week. The initial treatment target was an increased hemoglobin level of 10–20 g/L per month, and subsequent adjustments would be made according to the patient's hemoglobin level, speed of hemoglobin change, and treatment response. Oral iron can be accepted when STAT ≤ 20% or sFt ≤ 100 µg/L while intravenous iron is not permitted during the study. The use of statins and phosphate binders was allowed.