Introduction: The efficacy of oral roxadustat in dialysis patients with renal anemia and overt infections remains uncertain.Objectives: In this retrospective cohort study, 2816 such patients were screened, of whom 167 were enrolled and assigned to either roxadustat (n = 88) or recombinant human EPO (rHuEPO; n = 79) for treatment.Methods and results: Baseline hemoglobin levels were 90.3 ± 15.2 g/L and 91.9 ± 17.8 g/L, respectively. All patients received a mean of 10.6 ± 3.3 days of infection treatment. Types of infection included pulmonary, peritoneal dialysis-associated peritonitis, catheterrelated, urinary tract, and others. Compared with rHuEPO, roxadustat led to significantly greater increases in hemoglobin and ΔHb, and more pronounced improvements in ferritin, transferrin saturation (TSAT), and hepcidin levels following infection. The analysis demonstrated that TSAT, hepcidin, dialysis modality, residual renal function, infection type, and PCT levels play critical roles in mediating the efficacy of roxadustat under active infection conditions. Among peritoneal dialysis patients, roxadustat was associated with significantly greater improvements in ΔHb, ferritin, and TSAT compared to rHuEPO. ΔHb values varied by infection type, with significantly higher increases in peritoneal dialysis-associated peritonitis and a trend toward larger ΔHb in other infections relative to those in pulmonary infections. Based on procalcitonin levels, more severe infections were correlated with lower ΔHb values.Conclusion: Overal, roxadustat was more effective than rHuEPO in ameliorating renal anemia in infected dialysis patients.

The determinants of roxadustat treatment failure in renal anemia remain elusive. This study sought to develop a nomogram for predicting the risk of treatment failure of roxadustat in peritoneal dialysis (PD) with renal anemia. A retrospective cohort analysis from January 1, 2019, to January 31, 2023, included 204 PD patients with renal anemia, stratified by attainment group (Hb ≥ 110 g/L, n = 103) or non-attainment (Hb < 110 g/L, n = 101) within 1 year treatment. Univariate and multivariate Cox proportional hazards regressions were employed to ascertain predictive factors and construct the nomogram. Nomogram efficacy was evaluated via C-index, time-dependent ROC, calibration plots, and decision curve analysis, with internal validation via tenfold cross-validation and 1000 bootstrap resampling iterations. The study identified PD duration, serum transferrin, cardiovascular comorbidities, and stains as significant predictors. The nomogram demonstrated moderate discrimination at 6 months (AUC: 0.717) and enhanced predictive accuracy at 12 months (AUC: 0.741). The predicted and actual risk probabilities were concordant, with clinical net benefits observed at six-month (8 to 53%) and twelve-month (27 to 84%) risk thresholds. This nomogram is a valuable tool for effectively predicting non-attainment risk and facilitating personalized management of renal anemia in PD patients treated with roxadustat.

Introduction: Finerenone and dapagliflozin have demonstrated renal protective effects in diabetic kidney disease, but real-world evidence on their combination in non-diabetic kidney disease (NDKD) remains scarce. We assessed whether their combination improves short-term proteinuria control versus monotherapy, with long-term trajectories explored as hypothesis-generating outcomes. Methods: This retrospective cohort study included 327 NDKD patients admitted to Nanjing Drum Tower Hospital (January 2022–March 2026). Patients were divided into three groups: finerenone monotherapy, dapagliflozin monotherapy, or combination therapy. Propensity score matching (PSM) was used to balance baseline characteristics. Short-term (3 months) efficacy, safety, and exploratory cost analysis were compared. Longitudinal data were analyzed using generalized estimating equations (GEE), with the primary inferential window at 3–6 months and a sensitivity analysis at 3–24 months. Multivariate logistic regression identified predictors of treatment failure in the full unmatched cohort. Exploratory subgroup analyses were performed in membranous nephropathy and hypertension. Results: After PSM, at 3 months, combination therapy achieved a higher overall remission rate than dapagliflozin monotherapy (69.57% vs. 39.13%, OR = 3.56, 95% CI: 1.50–8.40, P = 0.003), but not versus finerenone monotherapy (68.29% vs. 51.22%, OR = 2.05, 95% CI: 0.84–5.05, P = 0.115). In the primary 3–6 months GEE analysis, time effects were significant for clinical remission rates and proteinuria; Sensitivity GEE analysis (3–24 months) was consistent. Descriptive analyses from 3 to 24 months showed numerical improvement trends across groups, but these are exploratory. Adverse event rates were low, but the analysis was underpowered to exclude increased hyperkalemia risk. In exploratory cost analysis, the ICER was 22.99 RMB per 1% increase in remission rate versus finerenone and 20.79 RMB versus dapagliflozin; probabilistic sensitivity analysis was broadly consistent with the base case, without judgment of economic superiority. Dapagliflozin monotherapy was independently associated with treatment failure (OR = 2.163, 95% CI: 1.073–4.362, P = 0.031) in the full unmatched cohort. Exploratory subgroup analyses suggested potential benefit in membranous nephropathy and hypertension. Conclusion: Finerenone combined with dapagliflozin provides higher observed short-term (3 months) efficacy in NDKD, with low observed adverse event rates. Long-term outcomes require validation in larger prospective studies.