Abstract: Objective  This study aimed to investigate the relationship between fluctuations in hemoglobin levels and cardio-cerebrovascular events in dialysis patients initially treated with Roxadustat.  Methods  Dialysis patients who were initially treated with Roxadustat at Beijing Anzhen Hospital from June 2020 to May 2022 were selected and treated for 12 months. They were divided into low hemoglobin coefficient of variation group and high hemoglobin coefficient of variation group according to the mean hemoglobin variability coefficient. The relationship between fluctuations in hemoglobin levels and cardio-cerebrovascular events during the treatment period was observed. According to the mean value of hemoglobin acquired target rate the patients were divided into a high hemoglobin acquired target rate subgroup and a low hemoglobin acquired target rate subgroup, and the effect of hemoglobin variation rate on cardio-cerebrovascular events was analyzed separately in the two subgroups, and the interaction P value was calculated.   Results  A total of 77 patients were enrolled. Among these patients, 55 patients were treated with Roxadustat alone and 22 patients were treated with erythropoietin. During the 12-month treatment period, the low hemoglobin coefficient of variation (n=39) after hemoglobin compliance rate was higher than the high hemoglobin coefficient of variation group (n=38) (Z=-5.570, P=0.001), while the proportion of cardiovascular and cerebrovascular events was significantly lower than the high hemoglobin coefficient of variation group (23.08% vs. 55.26%, χ2=          -1.408, P=0.024). Kaplan-Meier analysis showed that the incidence of cardio-cerebrovascular events in the high hemoglobin coefficient of variation group was significantly higher than that in the low hemoglobin coefficient of variation group (χ2=5.012, P=0.025). The results of the multivariate Cox regression analysis showed that the hemoglobin variation coefficient was an independent risk factor for cardio-cerebrovascular events (OR=2.935, 95% CI:1.157～7.446, P=0.023). The results of the subgroups showed that regardless of whether the hemoglobin acquired target rate was high or low, a high hemoglobin variation coefficient would increase the risk of cardio-cerebrovascular events in patients (chi-squareed=1.51, interaction P=0.244).  Conclusion  When using Roxadustat to treat anemia in maintenance dialysis patients, high hemoglobin variation coefficient may increase the risk of cardiovascular and cerebrovascular events in patients. 

Key words: Hemoglobin fluctuation, Cardio-cerebrovascular event, Dialysis, Roxadustat