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This case describes a 32-year-old female with stage 5 chronic kidney disease (CKD), systemic lupus erythematosus (SLE), and severe anemia. Despite treatment with iron supplementation and erythropoiesis-stimulating agent (ESA) erythropoietin (EPO), her hemoglobin remained suboptimal. Initially, she received intravenous iron (100 mg for five days), followed by daily oral ferrous succinate (200 mg), regular hemodialysis, and weekly EPO injections (10,000 units). Although iron levels improved, hemoglobin stayed below target. The challenge was the poor response to EPO, likely due to functional iron deficiency and impaired iron utilization caused by chronic inflammation. After three months, the regimen was adjusted, introducing roxadustat, a hypoxia-inducible factor prolyl hydroxylase inhibitor (HIF-PHI), while discontinuing oral iron. Roxadustat was administered at 70 mg three times weekly, resulting in a significant increase in hemoglobin to above 110 g/L within a month, despite unchanged iron parameters. The case’s uniqueness lies in the successful use of roxadustat over EPO in this complex scenario. Roxadustat stabilizes hypoxia-inducible factors, improving iron mobilization and erythropoiesis, offering a more effective approach in managing anemia in patients with CKD and SLE, where traditional ESA therapy may fail.

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Treatment of a Patient with Severe Anemia and Systemic Lupus Erythematosus

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  • 出版模式：

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  • 发表日期：

    2025年

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  • Kewei Xie,
  • Huihua Pang,
  • Renhua Lu,
  • Leyi Gu

摘要

This case describes a 32-year-old female with stage 5 chronic kidney disease (CKD), systemic lupus erythematosus (SLE), and severe anemia. Despite treatment with iron supplementation and erythropoiesis-stimulating agent (ESA) erythropoietin (EPO), her hemoglobin remained suboptimal. Initially, she received intravenous iron (100 mg for five days), followed by daily oral ferrous succinate (200 mg), regular hemodialysis, and weekly EPO injections (10,000 units). Although iron levels improved, hemoglobin stayed below target. The challenge was the poor response to EPO, likely due to functional iron deficiency and impaired iron utilization caused by chronic inflammation. After three months, the regimen was adjusted, introducing roxadustat, a hypoxia-inducible factor prolyl hydroxylase inhibitor (HIF-PHI), while discontinuing oral iron. Roxadustat was administered at 70 mg three times weekly, resulting in a significant increase in hemoglobin to above 110 g/L within a month, despite unchanged iron parameters. The case’s uniqueness lies in the successful use of roxadustat over EPO in this complex scenario. Roxadustat stabilizes hypoxia-inducible factors, improving iron mobilization and erythropoiesis, offering a more effective approach in managing anemia in patients with CKD and SLE, where traditional ESA therapy may fail.