Efficacy of roxadustat for anaemia in kidney transplant recipients and its drug–drug interaction with tacrolimus: A retrospective cohort study

Introduction Post‐transplant anaemia is common in kidney transplant recipients (KTRs). Roxadustat is a novel renal anaemia therapy, but its efficacy, safety and interaction with tacrolimus (TAC) in KTRs require further investigation. Methods We conducted a retrospective single‐centre cohort study of 145 KTRs with post‐transplant anaemia (PTA) (March 2021 to March 2025), stratified by treatment into recombinant human erythropoietin (rhEPO, n = 73) and roxadustat (ROX, n = 72) groups. Endpoints included haemoglobin (Hb) changes, treatment response rates, liver and kidney function markers and TAC pharmacokinetics (trough concentration [C 0 ], dose [D] and C 0 /D ratio) at 1, 3 and 6 months. Results For both groups, at all follow‐up points, Hb levels increased significantly from baseline (all P < .05). At 6 months, compared to the rhEPO group, the ROX group showed a significantly higher treatment response rate (∆Hb > 10 g/L: 94.44% vs . 78.08%, P = 0.004) and greater Hb > 120 g/L achievement (80.56% vs . 65.75%, P = .044). No liver/kidney adverse effects were observed in either group. TAC exposure was unchanged in the rhEPO group, while in the ROX group, the C 0 increased significantly at 1 and 3 months ( P < .05), and C 0 /D was prominently higher than baseline at 1, 3 and 6 months ( P < .01). Conclusion Roxadustat is an effective oral treatment for PTA, demonstrating superior efficacy to rhEPO at 6 months. However, it is associated with a significant drug–drug interaction that may increase TAC exposure. These findings warrant further prospective studies to validate this drug–drug interaction.