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      Clinical parameters among patients in Japan with anemia and non-dialysis-dependent chronic kidney disease with and without diabetes mellitus who received roxadustat

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          Abstract

          Background

          Roxadustat is an oral hypoxia-inducible factor prolyl hydroxylase inhibitor for treating anemia of chronic kidney disease (CKD). This post hoc analysis of a Japanese, open-label, partially randomized, phase 3 study in patients with non-dialysis-dependent (NDD) CKD evaluated disease state–related parameters among patients with and without diabetes mellitus who received roxadustat. In the 1517-CL-0310 study (NCT02988973), roxadustat was noninferior to darbepoetin alfa for change in average hemoglobin levels at Weeks 18–24 from baseline who received roxadustat.

          Methods

          Patients enrolled in the 1517-CL-0310 study who received roxadustat were included in this post hoc analysis. Hematologic (hemoglobin, reticulocyte/erythrocyte ratio, mean corpuscular volume [MCV], and mean corpuscular hemoglobin [MCH]), iron-related (ferritin, total iron-binding capacity, transferrin, ceruloplasmin, and hepcidin), metabolic (HbA1c, glycated albumin, total cholesterol, low-density lipoprotein cholesterol, and high-density lipoprotein cholesterol), and renal (eGFR) parameters were summarized descriptively by visit through Week 52.

          Results

          Among 201 included patients, 105 (52.2%) and 96 (47.8%) were in the Diabetes and No Diabetes subgroups, respectively. There were no clinically meaningful differences through Week 52 for most hematologic, iron-related, metabolic, or renal parameters between patients in the Diabetes and No Diabetes subgroups. MCV and MCH remained lower and HbA1c and glycated albumin remained higher in patients in the Diabetes subgroup through Week 52. Both subgroups experienced a similar benefit from roxadustat in maintaining hemoglobin levels in the target range of 10–12 g/dL.

          Conclusion

          Roxadustat maintained hemoglobin levels in the target range with similar clinical parameters irrespective of diabetes mellitus presence at baseline.

          Supplementary Information

          The online version contains supplementary material available at 10.1007/s10157-022-02225-w.

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          Most cited references35

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          HIF-1-mediated expression of pyruvate dehydrogenase kinase: a metabolic switch required for cellular adaptation to hypoxia.

          Activation of glycolytic genes by HIF-1 is considered critical for metabolic adaptation to hypoxia through increased conversion of glucose to pyruvate and subsequently to lactate. We found that HIF-1 also actively suppresses metabolism through the tricarboxylic acid cycle (TCA) by directly trans-activating the gene encoding pyruvate dehydrogenase kinase 1 (PDK1). PDK1 inactivates the TCA cycle enzyme, pyruvate dehydrogenase (PDH), which converts pyruvate to acetyl-CoA. Forced PDK1 expression in hypoxic HIF-1alpha null cells increases ATP levels, attenuates hypoxic ROS generation, and rescues these cells from hypoxia-induced apoptosis. These studies reveal a hypoxia-induced metabolic switch that shunts glucose metabolites from the mitochondria to glycolysis to maintain ATP production and to prevent toxic ROS production.
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            Mechanisms of anemia in CKD.

            Anemia is a common feature of CKD associated with poor outcomes. The current management of patients with anemia in CKD is controversial, with recent clinical trials demonstrating increased morbidity and mortality related to erythropoiesis stimulating agents. Here, we examine recent insights into the molecular mechanisms underlying anemia of CKD. These insights hold promise for the development of new diagnostic tests and therapies that directly target the pathophysiologic processes underlying this form of anemia.
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              Roxadustat Treatment for Anemia in Patients Undergoing Long-Term Dialysis

              Roxadustat is an oral hypoxia-inducible factor prolyl hydroxylase inhibitor that stimulates erythropoiesis and regulates iron metabolism. Additional data are needed regarding the effectiveness and safety of roxadustat as compared with standard therapy (epoetin alfa) for the treatment of anemia in patients undergoing dialysis.
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                Author and article information

                Contributors
                keiko.tanaka@astellas.com
                Journal
                Clin Exp Nephrol
                Clin Exp Nephrol
                Clinical and Experimental Nephrology
                Springer Nature Singapore (Singapore )
                1342-1751
                1437-7799
                24 April 2022
                24 April 2022
                2022
                : 26
                : 9
                : 843-850
                Affiliations
                [1 ]GRID grid.410714.7, ISNI 0000 0000 8864 3422, Department of Nephrology, , Showa University School of Medicine, ; Tokyo, Japan
                [2 ]GRID grid.418042.b, ISNI 0000 0004 1758 8699, Medical Specialty, Japan Medical Affairs, , Astellas Pharma, Inc., ; 2-5-1, Nihonbashi-Honcho, Chuo-ku, Tokyo, 103-8411 Japan
                [3 ]GRID grid.418042.b, ISNI 0000 0004 1758 8699, Japan-Asia Clinical Development, Astellas Pharma, Inc., ; Tokyo, Japan
                [4 ]GRID grid.418042.b, ISNI 0000 0004 1758 8699, Data Science, Development, , Astellas Pharma, Inc., ; Tokyo, Japan
                Article
                2225
                10.1007/s10157-022-02225-w
                9385792
                35462610
                7873f106-62da-46c3-b4a7-653a374b73a3
                © The Author(s) 2022

                Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

                History
                : 3 December 2021
                : 5 April 2022
                Funding
                Funded by: Astellas Pharma, Inc.
                Categories
                Original Article
                Custom metadata
                © The Author(s), under exclusive licence to The Japanese Society of Nephrology 2022

                Nephrology
                anemia,chronic kidney disease,diabetes mellitus,roxadustat
                Nephrology
                anemia, chronic kidney disease, diabetes mellitus, roxadustat

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