Abstract: 【Abstract】Objective To investigate the effectiveness and safety of erythropoietin (EPO) combined with low dose Roxadustat in hemodialysis patients whose hemoglobin (Hb) levels remained below the target range under EPO therapy. Methods The hemodialysis patients treated in Peking University Third Hospital from January 2020 to September 2021 and having renal anemia not to be reversed to the target range by EPO were retrospectively reviewed. Their EPO dose could not be further increased because of the already higher EPO dose they took, the possible side-effects of high EPO dose, or the unaffordable cost of Roxadustat of the patients. The changes of Hb level, doses of EPO and Roxadustat, dialysis regimens, iron supplements, ultrasensitive C-reactive protein (us-CRP), intact parathyroid hormone (iPTH), acidosis (CO2CP), and others before the combined therapy and after 6 months of the therapy were analyzed. Results A total of 38 patients received combined therapy. The Hb gradually decreased in the 6 months before the addition of Roxadustat compared with the 3 months and the 0 months (t=6.689, 4.910, respectively，both P<0.001). EPO dose did not change significantly (t=-1.686, -1.937, P=0.102, 0.088, respectively). Transferrin saturation (TSAT) and ferritin (SF) were in the target range. After the combination therapy with low-dose Roxadustat [(211.9 ±12.5) mg/week] for 1, 3 and 6 months, the dose of EPO had no significant change compared with month 0 (t=0.583, -1.303, - 1.402, P=0.563, 0.201, 0.180). Hb gradually increased at 1, 3 and 6 months after combined treatment (t=-4.788, -5.162, -5.910, respectively. P<0.001 in all). TSAT decreased slightly without statistically significance (t=1.967, P=0.064); SF decreased significantly (t=2.259, P=0.037). Before and after the combined therapy, dialysis regimen and intravenous iron dose had no changes; us-CRP, iPTH, and CO2CP levels also had no changes (t=-1.989, -1.743 and 0.946 respectively; P=0.427, 0.464 and 0.352 respectively). No adverse events were found during the combined therapy. Conclusion For hemodialysis patients who cannot maintain the Hb target with EPO alone, combined use of low-dose Roxadustat is safe and effective.

Key words: Renal anemia, Hemodialysis, Erythropoietin, Roxadustat