Abstract: 】Objective To explore the clinical efficacy and safety of Roxadustat in treatment of renal anemia in the initial hemodialysis patients. Methods A total of 90 patients with renal anemia at the initial hemodialysis stage and treated in Jiangxi Provincial Clinical Nephrology Research Center of Chinese Medicine -
Jiujiang Hospital of Chinese Medicine in the period from November 2019 to January 2021 were enrolled in
this study. They used Roxadustat for renal anemia for the first time. Roxadustat was continuously used for 12
weeks. Hemoglobin, erythrocyte count, serum iron, serum ferritin, transferrin saturation, albumin (ALB), C-reactive protein (CRP), triacylglycerol, total cholesterol, erythropoietin (EPO), hypoxia- inducible factor- 2α
(HIF-2α), prolyl hydroxylase (PHD2) and von Hipper Lindau tumor suppressor protein (pVHL) were measured before and after the Roxadustat treatment. The adverse reactions of Roxadustat were also recorded. Results After the treatment for 12 weeks, the compliance rate of hemoglobin was 76.67%, serum iron increased
(t=2.104, P=0.037), serum ferritin decreased (t=2.117, P=0.035), and transferrin saturation value remained stable; serum ALB, EPO and HIF2α increased (t=1.000, 29.071 and 10.709 respectively; P=0.318, 0.001 and
0.001 respectively), and CRP, PHD2 and pVHL decreased (t=7.904, 22.662 and 5.873 respectively; P=0.001),
as compare with those before the treatment. Adverse reactions of Roxadustat therapy included hyperkalemia
(3 cases), gastrointestinal symptoms (4 cases), infections (3 cases), chest tightness and discomfort (2 cases)
and dizziness (one case); they all improved after symptomatic treatment. Conclusion Roxadustat can effec-tively improve renal anemia in patients at the initial hemodialysis stage, probably relating to its actions on regulating HIF2α/PHD2/EPO signaling pathway, improving iron metabolism, and inhibiting micro-inflammatory
state in these patients. 

Key words: Roxadustat, Renal anemia, Initial hemodialysis, HIF2α/PHD2/EPO pathway, Clinical efficacy