# Frequency-reduction strategy of roxadustat in patients undergoing peritoneal dialysis: a multi-center retrospective cohort study

## TL;DR

This study compares two strategies for reducing roxadustat in peritoneal dialysis patients and finds that reducing dosing frequency is more effective at maintaining target hemoglobin levels.

## Contribution

Demonstrates that frequency-reduction of roxadustat is more effective than dose-reduction in maintaining hemoglobin levels in PD patients.

## Key findings

- Frequency-reduction group had higher hemoglobin target attainment rates at months 3, 6, and 12 compared to dose-reduction group.
- Frequency-reduction group showed lower hemoglobin variability and reduced risk of hemoglobin target non-attainment.
- Frequency-reduction strategy was associated with adjusted hazards ratio of 0.64 for hemoglobin target non-attainment.

## Abstract

Although dose reduction is the guideline-recommended tapering strategy for roxadustat to maintain target hemoglobin levels in peritoneal dialysis (PD) patients during the maintenance phase, reducing the administration frequency represents another potential clinical approach. However, the specific efficacy of this strategy in sustaining target hemoglobin levels remains unclear.

This was a retrospective cohort study conducted from 1 January 2021 to 31 December 2024, enrolling PD patients from three dialysis centers in South China. Participants who achieved target hemoglobin levels were stratified into two groups based on roxadustat tapering strategies: The dose-reduction group, in which the per-dose amount was gradually decreased while maintaining the administration frequency, and the frequency-reduction group, in which the administration frequency was reduced without changing the per-dose amount. During a 12-month follow-up period, with assessments conducted every 3 months, mean hemoglobin levels, hemoglobin target attainment rates, and hemoglobin variability—evaluated using the residual standard deviation (RSD) method—were compared between the two tapering strategies. The association between hemoglobin target non-attainment and tapering strategies was analyzed using Cox proportional hazards models.

Among the 402 PD patients included in the analysis, the mean age was 45.3 ± 13.8 years and 55.5% were male. No significant difference was observed in the hemoglobin change trend and mean hemoglobin levels between the two groups throughout the follow-up period. Compared to the dose-reduction group, the patients who reduced dosing frequency demonstrated significantly higher hemoglobin target attainment rates at months 3 (64.1% vs. 40.4%), 6 (55.6% vs. 43.2%), and 12 (49.2% vs. 36.6%; all p < 0.05). In addition, the patients in this group exhibited a lower mean Res-SD value (12.3 vs. 15.5; p < 0.05). Moreover, the frequency-reduction strategy was associated with a significantly lower risk of hemoglobin target non-attainment (adjusted hazards ratio [HR] 0.64, 95% CI 0.50–0.82; p < 0.001).

Compared to the dose-reduction group, the frequency-reduction group showed higher hemoglobin target attainment rates, lower hemoglobin variability, and a reduced risk of hemoglobin target non-attainment. The frequency-reduction strategy appears to be a potential tapering approach for peritoneal dialysis (PD) patients.