Safety and Effectiveness of Erythropoietin vs. Roxadustat for Anemia in Hemodialysis-Dependent Peridialytic CKD Patients: An Observational, Retrospective, Matched, Real-World Study

Background: Current evidence remains elusive about the efficacy and safety of erythropoietin versus roxadustat for anemia treatment in the peridialytic period. Methods: This study extracted longitudinal data from a metropolis-wide hospitals-based database Tianjin Healthcare and Medical Big Data Platform. Subjects with CKD stage G5 and anemia (hemoglobin <100 g/L) who had received treatment with erythropoietin or roxadustat between January 1, 2015 and December 31, 2021. Results: Of 40,324 patients who were included and treated with erythropoietin and erythropoietin 10,000 IU were matched to 545 patients treated with roxadustat. Significant differences were observed in the rates of MACE+ events as well as cardiocerebrovascular events. Conclusion: Erythropoietin, particularly erythropoietin 10,000 IU, improved hemoglobin response and exhibited better cardiovascular safety, as compared with roxadustat, in patients with anemia who had hemodialysis-dependent CKD in the peridialytic period.The rates of MACE+ events within 6 and 12 months of treatment initiation, within 3 months of hemodialysis initiation and during 12 months of follow-up among patients who were treated with roxadustat, erythropoietin, or erythropoietin 10,000 IUCOX regression analysis showed that receipt of roxadustat was associated with an approximately two-fold increase in the risk of MACE+ versus erythropoietin 10,000 IU (HR=2.17, 95% CI 1.95-2.43; P<0.001).