Objective  To explore the clinical efficacy of Roxadustat versus recombinant human erythropoietin in peritoneal dialysis （PD） patients with renal anemia in the real world.

Methods  A total of 90 PD patients regularly visiting from October 2020 to October 2021 were selected. According to different treatment options, they were divided into two groups of control （recombinant human erythropoietin, n=39） and experiment （Roxadustat group, n=44）. Control group received a subcutaneous injection of rHuEPO 100-150 IU/kg thrice a week. Experiment group received Roxadustat capsule orally at 100 mg for body weight <60 kg and 120 mg thrice a week for body weight ≥60 kg. At the beginning of follow-ups, blood routine was examined every 4 weeks and iron metabolism, biochemical and other laboratory parameters were measured at Week 12/24. The total treatment course was 24 weeks. The improvements of anemia, iron metabolism and biochemical parameters in two groups were recorded.

Results  After 24-week follow-ups, 44 cases in experiment group and 39 cases in control group completed this study. At Week 24, hemoglobin （Hb） level of experimental group was significantly higher than that of control group （120.02 ± 17.79）g/L vs （113.13 ± 9.40） g/L, P=0.028. At the end of follow-ups, the levels of transferrin （2.86 ± 0.57）g/L vs （2.17 ± 0.37） g/L, P<0.001, serum iron （19.94 ± 5.11） μmol/Lvs （15.52 ± 7.46） μmol/L, P=0.002 and total iron binding capacity （61.29 ± 16.77） μmol/L vs （54.68 ± 12.50） μmol/L, P=0.047 were higher in experimental group than those in control group while transferrin saturation was significantly lower than that in control group （12.67 ± 4.30）% vs （20.64 ± 6.56）%,P<0.001. No significant inter-group difference existed in ferritin （P=0.743）. Total cholesterol （3.45 ± 0.90） mmol/L vs （4.42 ± 0.99） mmol/L, P<0.001 and triglycerides （0.95 ± 0.30） mmol/Lvs （1.24 ± 0.59） mmol/L, P=0.007 were significantly lower in experimental group than those in control group. C-reactive protein （CRP） level was significantly lower in experimental group than that pre-treatment 0.51（0.23, 2.34） mg/L vs 2.42（0.59, 9.89） mg/L, P=0.001 while no significant difference existed in control group （P=0.968）. Within 24 weeks of follow-up, no significant inter-group statistical differences existed in total protein, albumin, serum creatinine, serum kalium, serum phosphorus or serum calcium.

Conclusion  Clinical efficacy of Roxadustat is not inferior to that of erythropoietin in improving anemia, iron metabolism, inflammation and lipid metabolism with renal anemia in PD patients.