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We reported a 70-year-old male patient on peritoneal dialysis presented with a 3-day history of fever, who was diagnosed with COVID-19 pneumonia by nucleic acid testing. The patient was started on recombinant human erythropoietin (rh-EPO) at a dosage of 3000 U twice a week for anemia treatment 3 years prior to admission. Hemoglobin levels remained between 107 and 120 g/L. After the admission, the patient was administered rhEPO, which he had been maintained for a long time and had a good therapeutic effect before he developed COVID-19. He was treated with a 5-day course of Paxlovid (1 tablet of nirmatrelvir and 1 tablet of ritonavir). Although his infection situation rapidly improved, the examination revealed a significant, continuous decrease in hemoglobin from 84g/L to 69g/L, even we provided treatment with 2U suspended red blood cells and increased the dosage of erythropoietin to 10000 U twice a week. The levels of biomarkers of iron storage and function were as follows: iron, 14.6 μmol/L; transferrin saturation, 16.8%; and ferritin, 641.7 μg/L. We switched his anemia medication to roxadustat with a dosage of 100 mg three times a week. The patient’s hemoglobin level stopped descending and gradually increased to 94 g/L after 4 weeks. The case suggests that roxadustat may be effective in the patient who was temporarily unsuitable for IV iron therapy and was hyporesponsive to high-dose ESA therapy because of intense inflammation like COVID-19.

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Use of a Hypoxia-Inducible Factor Prolyl Hydroxylase Inhibitor in a Peritoneal Dialysis Patient with Coronavirus Disease 2019

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  • 发表日期：

    2025年

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  • Minxia Li,
  • Yuehong Li,
  • Wei Wang,
  • Zhen Zhuang

摘要

We reported a 70-year-old male patient on peritoneal dialysis presented with a 3-day history of fever, who was diagnosed with COVID-19 pneumonia by nucleic acid testing. The patient was started on recombinant human erythropoietin (rh-EPO) at a dosage of 3000 U twice a week for anemia treatment 3 years prior to admission. Hemoglobin levels remained between 107 and 120 g/L. After the admission, the patient was administered rhEPO, which he had been maintained for a long time and had a good therapeutic effect before he developed COVID-19. He was treated with a 5-day course of Paxlovid (1 tablet of nirmatrelvir and 1 tablet of ritonavir). Although his infection situation rapidly improved, the examination revealed a significant, continuous decrease in hemoglobin from 84g/L to 69g/L, even we provided treatment with 2U suspended red blood cells and increased the dosage of erythropoietin to 10000 U twice a week. The levels of biomarkers of iron storage and function were as follows: iron, 14.6 μmol/L; transferrin saturation, 16.8%; and ferritin, 641.7 μg/L. We switched his anemia medication to roxadustat with a dosage of 100 mg three times a week. The patient’s hemoglobin level stopped descending and gradually increased to 94 g/L after 4 weeks. The case suggests that roxadustat may be effective in the patient who was temporarily unsuitable for IV iron therapy and was hyporesponsive to high-dose ESA therapy because of intense inflammation like COVID-19.