Clinical characteristics and influencing factors of roxadustat-induced central hypothyroidism in patients receiving peritoneal dialysis
Qinghua Yang, Jiaxiang Ding, Xiaoying Ren, Yuhui Lin, Mei WangBackground
This study aimed to investigate the clinical characteristics and risk factors of central hypothyroidism (CEH) in peritoneal dialysis (PD) patients treated with roxadustat.
Methods
This retrospective study enrolled maintenance PD patients followed up at Peking University International Hospital. During treatment of renal anemia with roxadustat in these patients, thyroid function [including thyroid-stimulating hormone (TSH), triiodothyronine (T3), thyroxine (T4), free triiodothyronine (FT3), and free thyroxine (FT4)] were assessed and monitored. The severity of hypothyroid symptoms in patients was assessed through questionnaires. The clinical characteristics and risk factors associated with CEH were analyzed.
Results
Among 76 PD patients with renal anemia treated with roxadustat, 51 were male (67.1%) with the mean age of 58.25 ± 14.58 years. Among the cohort, 12 (15.8%) developed CEH, characterized by FT4, FT3, T4, and T3 levels below the lower reference limits and reduced TSH. All patients returned to baseline thyroid hormone levels after discontinuing roxadustat. Symptom questionnaires revealed mild hypothyroidism symptoms (scores 1–4) in seven patients (58.3%). Multivariate logistic regression identified baseline hypoalbuminemia as a risk factor: each 1 g/L increase albumin reduced the risk of CEH by 16.8%.
Conclusion
Roxadustat therapy for renal anemia is associated with an increased risk of CEH. Clinically, given the manifestations of hypothyroidism, regular monitoring of thyroid function, particularly changes in TSH levels from baseline, is recommended. Roxadustat should be discontinued if CEH occurs during treatment, and thyroid function generally recovers following drug withdrawal. Multivariate analysis identified hypoalbuminemia as an independent risk factor for CEH. Therefore, thyroid function should be routinely monitored in PD patients before and during roxadustat therapy.