Roxadustat-associated hypothyroidism in maintenance hemodialysis patients

Renal anemia is prevalent in maintenance hemodialysis (MHD) patients, adversely affecting both quality of life and mortality. Roxadustat, a hypoxia-inducible factor prolyl hydroxylase inhibitor (HIF-PHI), is widely used to treat renal anemia. However, emerging evidence suggested that roxadustat may be associated with hypothyroidism. An understanding of the incidence and risk factors of roxadustat-associated hypothyroidism remains unclear. We retrospectively analyzed thyroid function in 98 MHD patients before, during, and after discontinuing roxadustat treatment. Changes in thyroid parameters were assessed using paired t-test or the Wilcoxon matched-pairs signed rank test. Univariable and multivariable linear regression analyses were performed to identify factors associated with changes in thyroid function. We found that 11.22% of MHD patients developed hypothyroidism, and 16.33% exhibited concurrent reductions in FT3 and TSH levels after roxadustat treatment. The median time from treatment modification to normalization of thyroid function was 46 days. Baseline TSH remained independently associated with ΔTSH, whereas inflammatory markers, nutritional indicators, and dialysis-related parameters were not significantly associated with thyroid function changes. In conclusion, regular thyroid function monitoring should be considered in patients receiving roxadustat for renal anemia. Further prospective studies are warranted to confirm these findings and clarify the underlying mechanisms.