Abstract: Objective  To investigate the efficacy of roxadustat combined with iron supplements in treating renal anemia in maintenance dialysis patients and its effects on the proline hydroxylase 2 (PHD2)/hypoxia-inducible factor (HIF)-2α pathway.  Methods  A total of 111 patients with renal anemia undergoing maintenance dialysis at Dazhou Dachuan District People’s Hospital from June 2021 to June 2023 were selected and divided into three groups using the random number table method. Control group 1 received roxadustat alone, control group 2 received iron supplements alone, and the combined group received roxadustat plus iron supplements. Anemia symptoms, hematological parameters, iron metabolism indices, PHD2/HIF-2α pathway markers, and adverse reactions were compared across the three groups.  Results  The total effective rate of the combined group was higher than that of the control group 1 (χ2=5.046, P=0.025) and the control group 2 (χ2=14.131, P＜0.001). Post-treatment scores for pallor, dizziness, chest tightness, and memory decline in the combined group were significantly lower than those in control groups 1 and 2 (F=52.085, 81.722, 81.208, 111.818; all P＜0.001). The combined group also showed higher post-treatment hemoglobin (Hb), hematocrit (Hct), red blood cell count (RBC), ferritin, transferrin, transferrin saturation (TSAT), and total iron-binding capacity (TIBC) compared to both control groups (F=44.763, 70.279, 37.997, 64.326, 24.704, 48.965, 52.505; all  P＜0.001). Conversely, unsaturated iron-binding capacity (UIBC), PHD2, HIF-1α, and HIF-2α levels were significantly lower in the combined group (F=49.801, 39.901, 62.073, 51.449; all P＜0.001). Conclusion  Roxadustat combined with iron therapy effectively improves anemia symptoms, hematological parameters, and iron metabolism in maintenance dialysis patients with renal anemia, potentially through modulation of the PHD2/HIF-2α pathway.

Key words: Maintenance dialysis, Renal anemia, Roxadustat, Iron, Iron metabolism, Proline hydroxylase 2/ hypoxia-inducible factor-2 α pathway