BACKGROUND:To compare the efficacy and safety profiles of obinutuzumab or cyclosporine combined with steroid in treating primary membranous nephropathy. METHODS:This retrospective study included patients with primary membranous nephropathy treated at Shanghai Ruijin Hospital between January 2020 and June 2023. Patients received either obinutuzumab or cyclosporine combined with corticosteroid and were followed for at least 24 months unless relapse or treatment failure occurred. Propensity score matching (PSM, ratio: 1:1) based on age, sex, degree of proteinuria, eGFR, serum albumin and PLA2R antibody was applied to pair patients receiving Obinutuzumab with those receiving cyclosporine combined with corticosteroid. The primary outcome was defined as the combination of partial remission and complete remission at 24 months. Logistic regression model and Kaplan-Meier curves were applied to compare the efficacy of two treatments. RESULTS:After PSM, 30 patients receiving obinutuzumab and 30 patients receiving cyclosporine with corticosteroid were included in the study. By 24 months, a higher proportion of patients in the obinutuzumab group reached the primary endpoints compared to those treated with cyclosporine combined with corticosteroid. (Obinutuzumab vs. Cyclosporine: 86 % vs. 54 %, P=0.01; HR:5.42, 95%CI:1.49-19.69, P=0.01). Relapses of nephrotic syndrome were less frequent in the obinutuzumab group than in the cyclosporine group (Obinutuzumab vs. Cyclosporine: 15% vs. 52%, P=0.01; HR:0.16, 95%CI: 0.04-0.60, P=0.01). Obinutuzumab induced a faster immunologic remission at 6 months (Obinutuzumab vs. Cyclosporine: 91% vs. 59%, P<0.01; HR: 7.22, 95% CI: 1.40-37.25, P=0.02) and maintained a better persistent immunologic remission at 24 months [Obinutuzumab vs. Cyclosporine: 95% vs. 45%, P<0.01; HR: 24.44, 95%CI: 2.73-219.09, P<0.01]. Both treatment regimens were generally well-tolerated. The incidence of infection was lower in the obinutuzumab group than in the cyclosporine combined with corticosteroid group (Obinutuzumab vs. Cyclosporine: 23% vs. 50%, P=0.03). CONCLUSIONS:Our study demonstrated that obinutuzumab is associated with higher remission rates at 24 months, faster immunological remission and less infections than cyclosporine combined with corticosteroids in the treatment of PMN.

PURPOSE:To evaluate the association between roxadustat use and renal outcomes, compared with erythropoiesis-stimulating agents (ESAs), in patients with non-dialysis-dependent chronic kidney disease (CKD) and anemia. METHODS:This retrospective cohort study included patients with CKD and anemia treated at Ruijin Hospital between January 2010 and December 2022 who had an estimated glomerular filtration rate (eGFR) ≥15 mL/min/1.73 m² at baseline. Patients treated with roxadustat were compared with those treated with ESAs. Propensity score matching was used to balance baseline characteristics between groups. The composite renal endpoint was defined as a ≥ 50% decline in eGFR, doubling of serum creatinine, or progression to end-stage kidney disease. Annual eGFR slopes were compared, and Cox proportional hazards models were used to assess the association between treatment and the composite renal endpoint. FINDINGS:After propensity score matching, 852 patients were included, with 426 in each group; more than 90% had stage 3-4 CKD. In the overall matched cohort, the annual decline in eGFR did not differ significantly between the roxadustat and ESAs groups. Among patients aged > 60 years, the median eGFR slopes were -1.84 and -3.50 mL/min/1.73 m²/yr in the roxadustat and ESAs groups, respectively (P = 0.02), whereas no significant difference was observed among those aged ≤ 60 years. In multivariable Cox models, exploratory analyses suggested possible effect modification by age (P for interaction = 0.03). The overall incidence of adverse events was comparable between groups (27.93% vs 29.34%; P = 0.65). IMPLICATIONS:Among patients with non-dialysis-dependent CKD and anemia, roxadustat and ESAs were associated with similar renal outcomes overall. Subgroup findings suggest possible heterogeneity in treatment effects by age. Further studies are warranted to clarify the clinical relevance of these findings.

ObjectiveTo analyze the clinical risk factors and prognosis of elderly peritoneal dialysis patients with peritonitis. MethodsA retrospective analysis was conducted on the data of patients who underwent peritoneal dialysis and developed peritonitis at this peritoneal dialysis center between January 2020 and November 2022. Patients were divided into 2 groups according to their age at peritonitis onset: an elderly peritonitis group (age≥65) and a non-elderly peritonitis group (age<65). General information and peritonitis-related data were collected, and the clinical risk factors and prognosis of peritonitis between the 2 groups were compared. ResultsA total of 62 patients with peritonitis were enrolled, including 26 in the elderly peritonitis group, where the median age was 71 (range 65-88), 12 patients were male (46.2%), and 5 patients had diabetic nephropathy complicated by diabetes mellitus (19.2%); 36 in the non-elderly peritonitis group, where the median age was 48 (range 26-63), 23 patients were male (63.9%), and 5 patients had diabetic nephropathy complicated by diabetes mellitus (13.9%). The elderly peritonitis group exhibited a worse prognosis than the non-elderly peritonitis group (mortality 30.8% vs. 2.8%; technique failure rates 23.1% vs. 16.7%, P=0.004). The elderly peritonitis group had a higher proportion of patients with education level of middle school or below (72.2% vs. 53.8%, P=0.038), a higher proportion requiring caregivers (100% vs. 83.3%, P=0.035), a higher frequency of operator changes (38.5% vs. 11.1%, P=0.011), longer initial training time (4 d vs. 3 d, P<0.01), and longer dialysis duration (70.5 months vs 29.5 months, P=0.002). The non-elderly peritonitis patients had better nutritional status: both normalized protein catabolic rate (nPCR) (0.90 vs. 0.79, P=0.007) and plasma albumin (34.78 g/L vs. 30.77 g/L, P<0.01) were higher. The elderly peritonitis group had lower levels of blood creatinine (872.42 μmol/L vs. 1053.69μmol/L, P<0.01), blood uric acid (345.0 μmol/L vs. 372.0 μmol/L, P=0.023), blood potassium (3.65 mmol/L vs. 3.95 mmol/L, P=0.012), blood phosphorus (1.54 mmol/L vs. 1.80 mmol/L, P=0.022), intact parathyroid hormone (iPTH) (227.2 pg/mL vs. 414.0 pg/mL, P=0.037), and 25-hydroxyvitamin D3 (17.95 nmol/L vs. 22.57 nmol/L, P=0.007). ConclusionsElderly patients with peritonitis had a poorer prognosis. Compared with younger patients with peritonitis, elderly patients had lower education levels, longer dialysis duration, worse nutritional status, poorer operational ability, and a greater need for caregivers.

Background: Vitamin D insufficiency (VDI) is a major driver of secondary hyperparathyroidism (SHPT) in chronic kidney disease (CKD). Extended-release calcifediol (ERC) is approved for SHPT in the United States, 11 European countries but not China. The present randomized controlled trial (RCT) evaluated ERC for Chinese adults with SHPT, stage 3–4 CKD and VDI. Methods: This RCT involved 100 adults with estimated glomerular filtration rate (eGFR) 15-<60 mL/min/1.73m², intact parathyroid hormone (iPTH) 85-<500 pg/mL and serum 25-hydroxyvitamin D (25D) 10-<30 ng/mL. Participants received daily ERC or placebo (randomized 2:1) for 26 weeks. Dosing started at 30 µg and increased, as needed, to 60 µg after 12 weeks. The primary efficacy endpoint was the proportion of participants attaining mean ≥ 30% decrease from baseline (BL) in iPTH during the last 6 weeks of treatment. A secondary efficacy endpoint was the proportion attaining mean 25D of ≥ 30 ng/mL. Safety endpoints included serum calcium and phosphorus, urine calcium:creatinine ratio and eGFR. Results: At BL, participants had mean age 52.6 years, body mass index 24.5 kg/m 2 , 25D 17.4 ng/mL, eGFR 24.1 mL/min/1.73m 2 ; 84% had stage 4 CKD; 49% were female. More participants achieved the targeted ≥ 30% reduction in iPTH with ERC than with placebo (53.0% vs 6.3%; p < 0.0001) and the proportion achieving 25D of ≥ 30 ng/mL was higher with ERC (90.9% vs 9.4%; p < 0.0001). No clinically meaningful differences in safety parameters were observed between treatment groups. Conclusion: ERC was well tolerated and effective for treating SHPT in Chinese adults with stage 3–4 CKD and VDI. Trial Registration: Chinese Clinical Trial Registry ChiCTR2600126426; registration date: June 9, 2026. Retrospectively registered.

Immunoglobulin A nephropathy (IgAN) is the most common primary glomerulonephritis and a leading cause of end-stage renal disease for young adults. The key pathogenesis of IgAN involves overproduction of galactose-deficient IgA1 (Gd-IgA1) and anti-Gd-IgA1 antibodies, resulting in formation of circulating immune complexes that deposit in the glomerular mesangium. Consequently, emerging therapeutic strategies for IgAN aim to target and reduce aberrant Gd-IgA1 and its associated immune complexes. This disease-modifying approach confers benefits across multiple stages of IgAN progression, particularly in the early phase to halt irreversible renal damage. B-cell activating factor (BAFF) and proliferation-inducing ligand (APRIL) are critical cytokines that promote the differentiation, development and activation of B cells and plasma cells. Telitacicept, a novel recombinant fusion protein that dual-targets BAFF and APRIL, exhibits considerable therapeutic potential by inhibiting the production of Gd-IgA1 and its autoantibodies. Stage A results of the Phase 3 clinical trial demonstrated that patients in the telitacicept group achieved a 55% reduction in 24-h urinary protein-to-creatinine ratio and stable estimated glomerular filtration rate at Week 39 versus the placebo group, with favorable tolerability and safety. This review summarizes current progresses in targeting Gd-IgA1-producing cells for the treatment of IgAN, with a focus on therapeutic strategies including BAFF/APRIL inhibitors. Furthermore, it delineates the major challenges and future research directions aimed at optimizing these interventions.

Patients undergoing peritoneal dialysis are at high risk of infection, which significantly impacts morbidity and mortality. This retrospective study aimed to evaluate the association of thymopentin use with infection risk, immune function, and inflammatory markers in peritoneal dialysis patients. Clinical data from 100 patients undergoing peritoneal dialysis were collected and analyzed. According to the treatment regimens received, patients were divided into a control group (standard therapy) and a thymopentin group (standard therapy combined with thymopentin). Thymopentin was administered subcutaneously at a dose of 10 mg daily for the first 5 days, followed by 10 mg three times per week (Monday, Wednesday, and Friday) for 23 consecutive weeks. Patients were followed for a total of 48 weeks. Infection rates, immune function, and levels of inflammatory markers were compared between the two groups. The thymopentin group demonstrated a lower infection incidence than the control group (0.73 vs. 1.00 per person-year). Thymopentin use was associated with significantly reduced overall infection rates (P < 0.001) and peritonitis (P = 0.031). Multivariate analysis confirmed a lower infection risk (HR = 0.54, 95

Renal excretion is a primary pathway for heavy metal metabolism. In this study, we established an animal model of molybdenum toxicity and found that Mo exposure led to structural and functional damage to the kidneys. Further multi-omics analyses identified a regulatory network involving ''Arachidonic acid metabolism,'' ''Steroid hormone biosynthesis,'' ''Folate biosynthesis,'' and ''Retrograde endocannabinoid signaling,'' which played a crucial role in the mechanism underlying renal heavy metal excretion injury induced by molybdenum exposure. Notably, the prominent upregulation of Epoxide hydrolase 2 was identified as a potential key biomarker. Additionally, Lecithin, Prostaglandin D2 synthase, NADH dehydrogenase [ubiquinone] flavoprotein 3, Testololactone, and Tetrahydrobiopterin were found to play significant roles in the excretion injury mechanism. This study provides new insights into the mechanism of heavy metal excretion loss and offers valuable directions for the prevention and treatment of kidney damage caused by environmental heavy metal exposure. Significance: We found that the regulatory network composed of ''Arachidonic acid metabolism,'' ''Steroid hormone biosynthesis,'' ''Folate biosynthesis,'' and ''Retrograde endocannabinoid signaling'' plays a crucial role in the mechanism of renal heavy metal excretion damage caused by molybdenum exposure. This study provides new insights into the mechanism of heavy metal excretion loss and offers valuable directions for the prevention and treatment of kidney damage caused by environmental heavy metal exposure.

KEY POINTS:IgA nephropathy (IgAN) patients with thickening of glomerular basement membrane had a higher risk of progressing to ESKD independent of international risk-prediction tool in IgAN. Thickening of glomerular basement membrane in IgAN patients was positively correlated with mesangial hyperplasia. BACKGROUND:Glomerular basement membrane (GBM) ultrastructural abnormalities are common in IgA nephropathy (IgAN); however, few studies have focused on clinical significance and prognostic value of GBM ultrastructural changes in IgAN patients. METHODS:A retrospective longitudinal cohort with 1006 biopsy-proven primary IgAN patients was collated. GBM thickness and texture of each case were assessed under transmission electron microscope. The primary end point was ESKD. Cox proportional hazards regression model was built to determine risk factors. Immunofluorescent staining was performed on patient kidney biopsy samples to validate the correlation between mesangial proliferation and abnormal GBM thickness. Twenty single nucleotide polymorphisms independently associated with IgAN in previous genome-wide association studies were genotyped in 617 patients, and whole exome sequencing was performed in 56 patients to investigate potential variants underlying GBM ultrastructural changes. RESULTS:Of 1006 patients, 52% were female, and the mean age was 37.3±12.3 years old. Among all patients, 80 (8%) had abnormal thickness of GBM including 29 (3%) thickening of GBM and 51 (5%) thinning of GBM. Abnormal GBM texture was found in 25 (2%) patients. During a mean follow-up time of 46.4 months, 91 (9%) patients progressed to ESKD. By Cox regression analyses, we demonstrated that thickening of GBM at biopsy increased the risk of ESKD before (hazard ratio [HR], 3.64; 95% confidence interval [CI], 1.47 to 7.55) and after adjusted by Oxford Scoring (HR, 2.92; 95% CI, 1.12 to 6.48) or international risk-prediction tool in IgAN (HR, 3.51; 95% CI, 1.41 to 7.29). Relevance analyses showed that GBM thickening was positively correlated with mesangial hyperplasia and proliferation, but not genetic variants in IgAN patients. CONCLUSIONS:Thickening of GBM correlated with mesangial hyperplasia and proliferation was associated with ESKD in IgAN patients, demonstrating the potential of incorporating ultrastructural changes into the pathologic evaluation system of IgAN.

Background:Immunoglobulin A nephropathy (IgAN) is one of the most common causes of primary glomerulonephritis that lacks a specific treatment option. This study aimed to evaluate the efficacy and safety of telitacicept in patients with IgAN. Methods:We performed a retrospective analysis in 82 biopsy-proven IgAN patients with baseline estimated glomerular filtration rate (eGFR) >20 mL/min/1.73 m2 and proteinuria ≥1 g/day. Forty-one patients were treated with telitacicept and angiotensin-converting enzyme inhibitor (ACEI)/angiotensin receptor blocker (ARB). They were divided into extended group (treated with telitacicept weekly for the first 6 months, then once every 2 weeks for the next 3-6 months) and short-term group (treated with telitacicept weekly for the first 6 months). The other 41 patients received ACEI/ARB alone and served as the ACEI/ARB group. Results:The mean percent change in proteinuria from baseline of extended group, short-term group and ACEI/ARB group were -56.8 ± 23.5% (P < .01), -28.6 ± 65.6% (P = .09) and -0.3 ± 57.0% at Month 12. eGFR decline in telitacicept groups were slower compared with the ACEI/ARB group. Univariate logistic regression analysis revealed only extended treatment (odds ratio = 4.3, 95% confidence interval 1.2-15.0, P < .05), but not short-term treatment was significantly associated with proteinuria decrease (defined as reduction in urine protein by more than 50%) at 12 months. This association remained robust after adjusting for age, gender, baseline eGFR or proteinuria. Subgroup analysis showed that the effect of extended treatment on reducing urine protein was more pronounced than that of short-term treatment in patients with higher proteinuria (≥2 g/day), poorer renal function (eGFR<60 mL/min/1.73 m2), or worse pathological changes (M1, E1, T1/T1 and C1/C2). The safety outcomes of telitacicept were similar to ACEI/ARB. No severe adverse events were reported in all groups. Conclusion:Our study confirms that telitacicept has a definite proteinuria-lowering effect in IgAN. Extending the treatment duration from 6 months to 9-12 months further enhances its ability to reduce proteinuria.

Introduction:IgA nephropathy (IgAN) is a leading cause of kidney failure, characterized by galactose-deficient IgA1 (Gd-IgA1) deposition and immune complex formation. Aberrant trafficking of IgA+ plasma cells and autoantibody production (IgG or IgA) contribute to disease pathogenesis. Proteasome inhibitors such as bortezomib may modulate B or plasma cell activity and reduce pathogenic antibody production. Methods:This open-label, prospective, uncontrolled trial evaluated bortezomib in adults with biopsy-confirmed IgAN, proteinuria > 1.5 g/d, and estimated glomerular filtration rate (eGFR) ≥ 30 ml/min per 1.73 m2 despite optimized care. Patients received 4 to 8 doses of i.v. bortezomib at 1.1 to 1.3 mg/m2 per dose. The primary end point was achieving 24-hour proteinuria (24 h-UP) < 300 mg/24 h at 12 months. Secondary end points included changes in eGFR and adverse event monitoring. Results:Sixteen patients completed the study. Median time from diagnosis to treatment was 63 months (range: 10-192). Baseline proteinuria was 2.719 g/24 h (95% confidence interval [CI]: 2.169-3.408), and mean eGFR was 51.1 ml/min per 1.73 m2 (95% CI: 41.3-60.8). At 12 months, proteinuria decreased by 44.67%, with 6.25% achieving complete remission and 43.75% achieving ≥ 50% reduction. Proteinuria reduction persisted at 24 months (mean: 1.411 g/24 h: 48.09% reduction). The annual eGFR slope was -4.275 ml/min per 1.73 m2. No serious treatment-related adverse events were reported. Conclusion:Short course bortezomib therapy led to sustained proteinuria reduction in patients with IgAN, with an acceptable safety profile. These results support further evaluation in larger, controlled trials.

To evaluate the occurrence of uremic pruritus among peritoneal dialysis (PD) patients and explore its correlation with serum iron levels. A cross-sectional study was carried out on 189 PD patients at a single center in China. The severity of pruritus was assessed through the validated 5-D Itch Scale questionnaire. The relationship between clinical factors and pruritus was examined using multivariate logistic regression, restricted cubic spline analysis, piecewise regression, and cluster analysis of iron metabolism patterns. Moderate/severe pruritus affected 27.5

This is the first phase 4 study evaluating safety and efficacy of enzyme replacement therapy (ERT) in Chinese patients with Fabry disease, and exploring the impact of COVID-19 infection on the prognosis of Fabry disease under ERT. Eligible patients received an infusion of agalsidase beta (1.0 mg/kg/2w) for up to 48 weeks. The primary endpoint was the safety of agalsidase beta. The endpoints of efficacy included changes in plasma globotriaosylceramide (GL-3), globotriaosylsphingosine (Lyso-GL-3), symptoms and estimated glomerular filtration rate (eGFR) from baseline to week 48. A post-hoc subgroup analysis was conducted by age group (< 30 years and ≥ 30 years) and in patients with or without COVID-19 infection. All 22 patients completed the study and 14 of them were infected by COVID-19. Treatment-related adverse events (AEs) and infusion-associated reactions (IARs) were reported in 8 participants (36.4 https://clinicaltrials.gov/study/NCT05054387

Trained immunity refers to the long-term memory of the innate immune cells. However, little is known about how environmental nutrient availability influences trained immunity. This study finds that physiologic carbon sources impact glucose contribution to the tricarboxylic acid (TCA) cycle and enhance cytokine production of trained monocytes. Our experiments demonstrate that trained monocytes preferentially employe lactate over glucose as a TCA cycle substrate, and lactate metabolism is required for trained immune cell responses to bacterial and fungal infection. Except for the contribution to the TCA cycle, endogenous lactate or exogenous lactate also supports trained immunity by regulating histone lactylation. Further transcriptome analysis, ATAC-seq, and CUT&Tag-seq demonstrate that lactate enhance chromatin accessibility in a manner dependent histone lactylation. Inhibiting lactate-dependent metabolism by silencing lactate dehydrogenase A (LDHA) impairs both lactate fueled the TCA cycle and histone lactylation. These findings suggest that lactate is the hub of immunometabolic and epigenetic programs in trained immunity.

BACKGROUND:HRS-5965 is an oral selective small-molecule inhibitor of complement factor B, a key component of the alternative pathway. This study assessed the safety, tolerability, pharmacokinetics, and pharmacodynamics of HRS-5965 in healthy participants and participants with renal insufficiency. METHODS:The first-in-human, phase 1 study consisted of 3 parts (ClinicalTrials.gov: NCT05505955). Part 1 was a single-ascending-dose, randomized, double-blind study with 5 dose groups preset, including a food effect evaluation. Part 2 was a multiple-ascending-dose, randomized, double-blind study with 9 dose groups preset. Part 3 was an open-label, single-dose study on severe renal insufficiency. The primary endpoints were safety and tolerability. FINDINGS:A total of 82 participants were enrolled and received either HRS-5965 or placebo (26 in part 1, 40 in part 2, and 16 in part 3). HRS-5965 was well tolerated. Treatment-emergent adverse events were comparable between the HRS-5965 groups and placebo groups in part 1 (17/20 [85.0%] vs. 6/6 [100.0%]) and part 2 (27/30 [90.0%] vs. 10/10 [100.0%]). No deaths were reported. HRS-5965 was absorbed rapidly, with a median time to reach peak concentration (Tmax) ranging from 0.75 to 1.50 h in fasted states and 2.00 h in fed states. Pharmacokinetics was nonlinear, and food delayed the absorption of HRS-5965 but did not impact the exposure. Alternative pathway activity was inhibited by over 80% with HRS-5965, compared to less than 20% with placebo. CONCLUSION:HRS-5965 demonstrated favorable safety and robust inhibition of alternative pathway activity, supporting further clinical development. FUNDING:The study was funded by Jiangsu Hengrui Pharmaceuticals Co., Ltd.

Objectives: To observe the effect of roxadustat on lowering blood lipids in peritoneal dialysis (PD) patients beyond treating anemia. Methods: In a prospective, multicenter clinical study, we randomly assigned (in a 1:1 ratio) 100 PD patients who had received erythropoiesis-stimulating agent therapy for at least 4 weeks to receive either roxadustat or erythropoietin (EPO) for 48 weeks. The blood lipids, hemoglobin, blood pressure, blood glucose, iron metabolism and inflammatory factors were compared between the two groups at 0, 2, 4, 8, 12, 16, 20, 24 and 48 weeks, respectively. Results: At start of switching to roxadustat, hemoglobin seemed to rise a little faster (102.8 +/- 15.4 vs. 97.1 +/- 17.3 g/L at 2 weeks, p > 0.05), but there was no significant difference in hemoglobin change between the two groups over the course of observation (p = 0.185). At the early stage of the study (12 weeks), the transferrin saturation (TSAT) of roxadustat group decreased significantly from the baseline (32.7 (20.6) vs. 22.1 (18.7)%, p = 0.001). At the end of the study period (48 weeks), total cholesterol (3.89 +/- 0.92 vs. 4.52 +/- 1.14 mmol/L, p = 0.012), low density lipoprotein cholesterol (2.24 +/- 0.74 vs. 2.63 +/- 0.82 mmol/L, p = 0.045) and triglyceride (1.35 (0.86) vs. 1.89 (1.27) mmol/l, p = 0.013) in roxadustat group were significantly lower than those in EPO group. Conclusions: Roxadustat not only can improve anemia and iron metabolism, but also can reduce serum cholesterol and triglyceride levels in PD patients after switching from the EPO.

OBJECTIVES:To observe the effect of roxadustat on lowering blood lipids in peritoneal dialysis (PD) patients beyond treating anemia. METHODS:In a prospective, multicenter clinical study, we randomly assigned (in a 1:1 ratio) 100 PD patients who had received erythropoiesis-stimulating agent therapy for at least 4 weeks to receive either roxadustat or erythropoietin (EPO) for 48 weeks. The blood lipids, hemoglobin, blood pressure, blood glucose, iron metabolism and inflammatory factors were compared between the two groups at 0, 2, 4, 8, 12, 16, 20, 24 and 48 weeks, respectively. RESULTS:At start of switching to roxadustat, hemoglobin seemed to rise a little faster (102.8 ± 15.4 vs. 97.1 ± 17.3 g/L at 2 weeks, p > 0.05), but there was no significant difference in hemoglobin change between the two groups over the course of observation (p = 0.185). At the early stage of the study (12 weeks), the transferrin saturation (TSAT) of roxadustat group decreased significantly from the baseline (32.7 (20.6) vs. 22.1 (18.7)%, p = 0.001). At the end of the study period (48 weeks), total cholesterol (3.89 ± 0.92 vs. 4.52 ± 1.14 mmol/L, p = 0.012), low density lipoprotein cholesterol (2.24 ± 0.74 vs. 2.63 ± 0.82 mmol/L, p = 0.045) and triglyceride (1.35 (0.86) vs. 1.89 (1.27) mmol/l, p = 0.013) in roxadustat group were significantly lower than those in EPO group. CONCLUSIONS:Roxadustat not only can improve anemia and iron metabolism, but also can reduce serum cholesterol and triglyceride levels in PD patients after switching from the EPO.