{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,1]],"date-time":"2026-06-01T19:16:01Z","timestamp":1780341361285,"version":"3.54.1"},"reference-count":35,"publisher":"Public Library of Science (PLoS)","issue":"3","license":[{"start":{"date-parts":[[2025,3,26]],"date-time":"2025-03-26T00:00:00Z","timestamp":1742947200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"the Science and technology development fund of Affiliated Hospital of Xuzhou Medical University","award":["XYFY202332"],"award-info":[{"award-number":["XYFY202332"]}]},{"DOI":"10.13039\/501100018636","name":"Xuzhou science and technology project","doi-asserted-by":"crossref","award":["KC23212"],"award-info":[{"award-number":["KC23212"]}],"id":[{"id":"10.13039\/501100018636","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec>\n<jats:title>\nBackground\n<\/jats:title>\n<jats:p>The COVID-19 pandemic has made treating renal anemia in chronic kidney disease (CKD) patients undergoing peritoneal dialysis (PD) difficult. The current study aims to compare roxadustat with erythropoiesis-stimulating agents (ESAs) during the COVID-19 pandemic.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>\nMethods\n<\/jats:title>\n<jats:p>We conducted a single-center, retrospective study during the COVID-19 outbreak in China, from December 7, 2022, to January 31, 2023. The study involved patients undergoing PD who were divided based on the medication used to treat renal anemia; the roxadustat group (n\u00a0=\u00a034) and the ESAs group (n = 120). We analyzed the effectiveness of treating anemia, cost, medication adherence, and clinical outcomes related to COVID-19. Patients were followed up for 9 months.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>\nResults\n<\/jats:title>\n<jats:p>The baseline of hemoglobin levels was (110.03 \u00b1 1.71\u00a0g\/L in the roxadustat and 110.1 \u00b1 1.52\u00a0g\/L in the ESAs groups, respectively), after 9 months of inspections, the levels of hemoglobin were (121.26 \u00b1 2.03\u00a0g\/L in the roxadustat and 118.49 \u00b1 1.35\u00a0g\/L in the ESAs groups, respectively). The roxadustat subgroup analysis indicated that total cholesterol and low-density lipoprotein levels in the roxadustat group decreased from baseline in subjects not receiving statins (3.39 \u00b1 0.12 vs. 4.2 \u00b1 0.21\u00a0mmol\/L and 2.21 \u00b1 0.23 vs. 3.65 \u00b1 0.37\u00a0mmol\/L, <jats:italic>P &lt; 0.05<\/jats:italic>). The Morisky score of the roxadustat group was higher [7 (5, 8) vs. 6 (4, 8), <jats:italic>P<\/jats:italic> &lt; 0.01]. The drug cost of the roxadustat group was higher, but another additional cost for correcting anemia was significantly reduced. The infection rate of COVID-19 and the mortality rate caused by COVID-19 were lower in roxadustat group.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>\nConclusion\n<\/jats:title>\n<jats:p>During the COVID-19 pandemic, both roxadustat and ESAs effectively improved renal anemia in PD patients, however, the roxadustat group experienced less additional costs for anemia correction and better medication compliance.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0320536","type":"journal-article","created":{"date-parts":[[2025,3,26]],"date-time":"2025-03-26T20:43:01Z","timestamp":1743021781000},"page":"e0320536","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":2,"title":["Roxadustat effectiveness versus ESAs in peritoneal dialysis patients during the COVID-19 pandemic: A retrospective study"],"prefix":"10.1371","volume":"20","author":[{"given":"Jie","family":"Liu","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kefan","family":"Zhou","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chen","family":"Meng","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhuzhu","family":"Liu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ruihua","family":"Huang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yousuf","family":"Waheed","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fan","family":"Yang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kun","family":"Liu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jiaqi","family":"Zhao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lin","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaoyan","family":"Yu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shuang","family":"Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tianyu","family":"Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yanshan","family":"Tong","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaodan","family":"Wei","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chuankuo","family":"Tian","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dong","family":"Sun","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3734-7898","authenticated-orcid":true,"given":"Xinglei","family":"Zhou","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2025,3,26]]},"reference":[{"issue":"7821","key":"pone.0320536.ref001","doi-asserted-by":"crossref","first-page":"430","DOI":"10.1038\/s41586-020-2521-4","article-title":"Factors associated with COVID-19-related death using OpenSAFELY","volume":"584","author":"EJ Williamson","year":"2020","journal-title":"Nature"},{"issue":"12","key":"pone.0320536.ref002","doi-asserted-by":"crossref","first-page":"705","DOI":"10.1038\/s41581-020-00349-4","article-title":"CKD is a key risk factor for COVID-19 mortality","volume":"16","author":"RT Gansevoort","year":"2020","journal-title":"Nat Rev Nephrol"},{"issue":"1","key":"pone.0320536.ref003","doi-asserted-by":"crossref","first-page":"27","DOI":"10.1016\/j.kint.2020.04.031","article-title":"COVID-19: clinical course and outcomes of 36 hemodialysis patients in Spain","volume":"98","author":"M Goicoechea","year":"2020","journal-title":"Kidney Int"},{"issue":"7","key":"pone.0320536.ref004","doi-asserted-by":"crossref","first-page":"831","DOI":"10.1001\/jamacardio.2020.1286","article-title":"Potential effects of coronaviruses on the cardiovascular system: a review","volume":"5","author":"M Madjid","year":"2020","journal-title":"JAMA Cardiol"},{"issue":"1","key":"pone.0320536.ref005","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1053\/j.ajkd.2020.03.008","article-title":"COVID-19 and dialysis units: What do we know now and what should we do?","volume":"76","author":"T Ikizler","year":"2020","journal-title":"Am J Kidney Dis"},{"issue":"1","key":"pone.0320536.ref006","doi-asserted-by":"crossref","first-page":"147","DOI":"10.1007\/s40620-019-00652-9","article-title":"Anemia and clinical outcomes in patients with non-dialysis dependent or dialysis dependent severe chronic kidney disease: a Danish population-based study","volume":"33","author":"G Toft","year":"2020","journal-title":"J Nephrol"},{"issue":"5","key":"pone.0320536.ref007","doi-asserted-by":"crossref","first-page":"1864","DOI":"10.1111\/j.1523-1755.2004.00584.x","article-title":"Anemia, hospitalization, and mortality in patients receiving peritoneal dialysis in the United States","volume":"65","author":"S Li","year":"2004","journal-title":"Kidney Int"},{"key":"pone.0320536.ref008","doi-asserted-by":"crossref","first-page":"1511596","DOI":"10.3389\/fneph.2024.1511596","article-title":"The role and clinical implications of HIF-PHI daprodustat in dialysis-dependent and non-dialysis-dependent chronic kidney disease anemic patients: a general review","volume":"4","author":"Y Waheed","year":"2024","journal-title":"Front Nephrol"},{"issue":"2","key":"pone.0320536.ref009","doi-asserted-by":"crossref","first-page":"90","DOI":"10.1038\/nrneph.2016.181","article-title":"Changes in the worldwide epidemiology of peritoneal dialysis","volume":"13","author":"PK-T Li","year":"2017","journal-title":"Nat Rev Nephrol"},{"issue":"2","key":"pone.0320536.ref010","doi-asserted-by":"crossref","first-page":"147","DOI":"10.3904\/kjim.2022.318","article-title":"The role of roxadustat in chronic kidney disease patients complicated with anemia","volume":"38","author":"J Liu","year":"2023","journal-title":"Korean J Intern Med"},{"issue":"3","key":"pone.0320536.ref011","doi-asserted-by":"crossref","first-page":"488","DOI":"10.3904\/kjim.2023.520","article-title":"A retrospective study on the efficacy of Roxadustat in peritoneal dialysis patients with erythropoietin hyporesponsiveness","volume":"39","author":"J Liu","year":"2024","journal-title":"Korean J Intern Med"},{"issue":"1","key":"pone.0320536.ref012","doi-asserted-by":"crossref","first-page":"49","DOI":"10.1053\/j.ajkd.2014.06.020","article-title":"A randomized, placebo-controlled trial of pentoxifylline on erythropoiesis-stimulating agent hyporesponsiveness in anemic patients with CKD: the Handling Erythropoietin Resistance With Oxpentifylline (HERO) trial","volume":"65","author":"DW Johnson","year":"2015","journal-title":"Am J Kidney Dis"},{"issue":"8","key":"pone.0320536.ref013","doi-asserted-by":"crossref","first-page":"372","DOI":"10.1159\/000508100","article-title":"A Phase 3, Multicenter, Randomized, Two-Arm, Open-Label Study of Intermittent Oral Dosing of Roxadustat for the Treatment of Anemia in Japanese Erythropoiesis-Stimulating Agent-Na\u00efve Chronic Kidney Disease Patients Not on Dialysis","volume":"144","author":"T Akizawa","year":"2020","journal-title":"Nephron"},{"issue":"11","key":"pone.0320536.ref014","doi-asserted-by":"crossref","first-page":"1011","DOI":"10.1056\/NEJMoa1901713","article-title":"Roxadustat Treatment for Anemia in Patients Undergoing Long-Term Dialysis","volume":"381","author":"N Chen","year":"2019","journal-title":"N Engl J Med"},{"issue":"11","key":"pone.0320536.ref015","doi-asserted-by":"crossref","first-page":"1001","DOI":"10.1056\/NEJMoa1813599","article-title":"Roxadustat for anemia in patients with kidney disease not receiving dialysis","volume":"381","author":"N Chen","year":"2019","journal-title":"N Engl J Med"},{"issue":"6","key":"pone.0320536.ref016","doi-asserted-by":"crossref","first-page":"2017","DOI":"10.21037\/apm-22-555","article-title":"Long-term efficacy, safety, and medication compliance of roxadustat on peritoneal dialysis patients with renal anemia affected by the COVID-19 pandemic: a retrospective study","volume":"11","author":"L Bao","year":"2022","journal-title":"Ann Palliat Med"},{"issue":"3","key":"pone.0320536.ref017","doi-asserted-by":"crossref","first-page":"471","DOI":"10.1053\/j.ajkd.2007.06.008","article-title":"KDOQI Clinical Practice Guideline and Clinical Practice Recommendations for anemia in chronic kidney disease: 2007 update of hemoglobin target","volume":"50","author":"Kdoqi","year":"2007","journal-title":"Am J Kidney Dis"},{"issue":"5","key":"pone.0320536.ref018","doi-asserted-by":"crossref","first-page":"348","DOI":"10.1111\/j.1751-7176.2008.07572.x","article-title":"Predictive validity of a medication adherence measure in an outpatient setting","volume":"10","author":"DE Morisky","year":"2008","journal-title":"J Clin Hypertens (Greenwich)"},{"issue":"2","key":"pone.0320536.ref019","doi-asserted-by":"crossref","first-page":"529","DOI":"10.1016\/j.jfma.2021.06.004","article-title":"Roxadustat treatment for anemia in peritoneal dialysis patients: A randomized controlled trial","volume":"121","author":"Y-P Hou","year":"2022","journal-title":"J Formos Med Assoc"},{"issue":"2","key":"pone.0320536.ref020","doi-asserted-by":"crossref","first-page":"147","DOI":"10.1111\/sdi.12940","article-title":"The reliability and success of peritoneal dialysis during the COVID-19 pandemic","volume":"34","author":"HH Yeter","year":"2021","journal-title":"Semin Dial"},{"key":"pone.0320536.ref021","doi-asserted-by":"crossref","first-page":"15","DOI":"10.1186\/1471-2466-10-15","article-title":"The prevalence of anemia and its association with 90-day mortality in hospitalized community-acquired pneumonia","volume":"10","author":"MC Reade","year":"2010","journal-title":"BMC Pulm Med"},{"issue":"4","key":"pone.0320536.ref022","doi-asserted-by":"crossref","first-page":"379","DOI":"10.1007\/s15010-011-0122-8","article-title":"Anemia and community-acquired pneumococcal pneumonia","volume":"39","author":"SM Doshi","year":"2011","journal-title":"Infection"},{"issue":"4","key":"pone.0320536.ref023","doi-asserted-by":"crossref","first-page":"1225","DOI":"10.1681\/ASN.2015030241","article-title":"Roxadustat (FG-4592): correction of Anemia in Incident Dialysis Patients","volume":"27","author":"A Besarab","year":"2016","journal-title":"J Am Soc Nephrol"},{"issue":"2","key":"pone.0320536.ref024","doi-asserted-by":"crossref","first-page":"115","DOI":"10.1111\/1744-9987.12888","article-title":"Intermittent oral dosing of roxadustat in peritoneal dialysis chronic kidney disease patients with anemia: a randomized, phase 3, multicenter, open-label study","volume":"24","author":"T Akizawa","year":"2020","journal-title":"Ther Apher Dial"},{"issue":"9","key":"pone.0320536.ref025","doi-asserted-by":"crossref","DOI":"10.3390\/nu13093138","article-title":"Dietary lipids and dyslipidemia in chronic kidney disease","volume":"13","author":"Z Kochan","year":"2021","journal-title":"Nutrients"},{"issue":"4","key":"pone.0320536.ref026","doi-asserted-by":"crossref","first-page":"451","DOI":"10.1001\/jama.291.4.451","article-title":"Association between cholesterol level and mortality in dialysis patients: role of inflammation and malnutrition","volume":"291","author":"Y Liu","year":"2004","journal-title":"JAMA"},{"issue":"22","key":"pone.0320536.ref027","doi-asserted-by":"crossref","first-page":"9382","DOI":"10.1074\/jbc.M117.788562","article-title":"Hypoxia-inducible factor 1\u03b1 activates insulin-induced gene 2 (Insig-2) transcription for degradation of 3-hydroxy-3-methylglutaryl (HMG)-CoA reductase in the liver","volume":"292","author":"S Hwang","year":"2017","journal-title":"J Biol Chem"},{"issue":"4","key":"pone.0320536.ref028","doi-asserted-by":"crossref","first-page":"608","DOI":"10.1161\/ATVBAHA.115.307136","article-title":"Hypoxia-inducible factor prolyl 4-hydroxylase-2 inhibition protects against development of atherosclerosis","volume":"36","author":"L Rahtu-Korpela","year":"2016","journal-title":"Arterioscler Thromb Vasc Biol"},{"issue":"4","key":"pone.0320536.ref029","doi-asserted-by":"crossref","first-page":"249","DOI":"10.1016\/j.jjcc.2013.04.008","article-title":"Effect of anemia correction on left ventricular hypertrophy in patients with modestly high hemoglobin level and chronic kidney disease","volume":"62","author":"M Akaishi","year":"2013","journal-title":"J Cardiol"},{"issue":"4","key":"pone.0320536.ref030","doi-asserted-by":"crossref","first-page":"238","DOI":"10.1536\/ihj.53.238","article-title":"Effects of anemia correction by erythropoiesis-stimulating agents on cardiovascular function in non-dialysis patients with chronic kidney disease","volume":"53","author":"M Suzuki","year":"2012","journal-title":"Int Heart J"},{"key":"pone.0320536.ref031","doi-asserted-by":"crossref","first-page":"667117","DOI":"10.3389\/fmed.2021.667117","article-title":"Effects of Roxadustat on the anemia and iron metabolism of patients undergoing peritoneal dialysis","volume":"8","author":"K Hirai","year":"2021","journal-title":"Frontiers in Medicine"},{"issue":"3","key":"pone.0320536.ref032","doi-asserted-by":"crossref","first-page":"109020","DOI":"10.1016\/j.celrep.2021.109020","article-title":"Hypoxic and pharmacological activation of HIF inhibits SARS-CoV-2 infection of lung epithelial cells","volume":"35","author":"PAC Wing","year":"2021","journal-title":"Cell Rep"},{"key":"pone.0320536.ref033","doi-asserted-by":"crossref","first-page":"e72","DOI":"10.26633\/RPSP.2020.72","article-title":"Ferritin levels and COVID-19","volume":"44","author":"M Vargas-Vargas","year":"2020","journal-title":"Pan Am J Public Health"},{"key":"pone.0320536.ref034","doi-asserted-by":"crossref","first-page":"130","DOI":"10.1016\/j.freeradbiomed.2018.09.043","article-title":"The development of the concept of ferroptosis","volume":"133","author":"T Hirschhorn","year":"2019","journal-title":"Free Radic Biol Med"},{"key":"pone.0320536.ref035","doi-asserted-by":"crossref","first-page":"104725","DOI":"10.1016\/j.nbd.2019.104725","article-title":"The drug adaptaquin blocks ATF4\/CHOP-dependent pro-death Trib3 induction and protects in cellular and mouse models of Parkinson\u2019s disease","volume":"136","author":"P Aim\u00e9","year":"2020","journal-title":"Neurobiol Dis"}],"container-title":["PLOS ONE"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0320536","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,3,26]],"date-time":"2025-03-26T20:44:59Z","timestamp":1743021899000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0320536"}},"subtitle":[],"editor":[{"given":"Ganesh Sritheran","family":"Paneerselvam","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2025,3,26]]},"references-count":35,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2025,3,26]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0320536","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,3,26]]}}}