Roxadustat for ESA-Hyporesponsive Renal Anemia in a 13-Year-Old on Hemodialysis: Case Report and Mini-Review.

Anemia is the most common complication of end-stage renal disease (ESRD). While erythropoiesis-stimulating agents (ESA) have improved treatment outcomes, some patients exhibit intolerance or hyporesponsiveness. Roxadustat, a hypoxia-inducible factor prolyl hydroxylase inhibitor (HIF-PHI), improves erythropoiesis and iron metabolism, offering advantages in ESA-refractory cases. However, its use in pediatric populations remains limited. We present a case of a 13-year-old girl on maintenance hemodialysis who exhibited both hyporesponsiveness and intolerance to ESA. Initiation of oral Roxadustat resulted in a sustained improvement in hemoglobin levels, accompanied by notable enhancements in iron metabolism and clinical symptoms. So far, over 5 years of follow-up, no significant adverse events were observed. Oral Roxadustat appears to be an effective and safe treatment option for teenage hemodialysis patients who are resistant or intolerant to ESA.