Abstract: Objective: This study aimed to investigate the effects of roxadustat on calcium and phosphorus metabolism, providing certain theoretical basis for clinical diagnosis and treatment. Methodology: In this multicenter cross-sectional study, 1573 maintenance hemodialysis patients from four tertiary hospitals were enrolled between January and March 2025. Participants were divided into roxadustat group (n=312) and erythropoiesis-stimulating agent (ESA) group (n=1261). Demographic characteristics and laboratory parameters were collected. Mann-Whitney tests and Multiple linear regression were used to analyze roxadustat’s effects on calcium-phosphorus metabolism. Results: Compared to the ESA group, patients in the roxadustat group were younger [56.0(47.0,65.0) years vs 59.0(50.0,68.0) years, P=0.004], had a shorter dialysis vintage [38.0(10.8,98.0) months vs 57.0(24.0,107.0) months, P<0.0001], a higher dry weight [64.8(56.0,73.5) kg vs 62.0(53.5,70.9) kg, P<0.0001], a lower serum albumin level [40.0(36.4,42.4) g/L vs 40.7(37.4,43.2) g/L, P=0.007], a lower low-density lipoprotein level [2.1(1.5,2.7) mmol/L vs 2.3(1.8,2.8) mmol/L, P=0.003], a lower proportion of phosphate binder use [51.3% vs 63.8%, P<0.0001], a higher total iron-binding capacity [55.6(46.9,62.9) μmol/L vs 50.0(43.0,57.6) μmol/L, P<0.0001], and a lower EPO level [9.5(5.2,17.2) mIU/mL vs 17.0(7.2,54.2) mIU/mL, P<0.0001]. There were no significant differences between the two groups in terms of gender distribution, type of dialysis access, dialysis schedule, proportion of iron use, calcium-based agents, and cinacalcet, as well as hemoglobin level, or ferritin level (all P>0.05). Further analysis revealed that the roxadustat treatment group had lower blood calcium levels [2.21(2.07,2.35) mmol/L vs 2.24(2.08,2.39) mmol/L, P=0.031] and intact parathyroid hormone (iPTH) levels [252(129,459) pg/mL vs 299(171,503) pg/mL, P=0.022] compared to the ESA group, while there was no difference in blood phosphorus levels between the two groups [1.94(1.55,2.38) mmol/L vs 1.85(1.49,2.34) mmol/L, P=0.164]. Multiple regression analysis showed that roxadustat was an independent influencing factor for serum calcium (β=-0.0481, 95%CI -0.0937~-0.0025, P=0.039) and iPTH (β=-64.8500, 95%CI -126.0000~-3.6990, P=0.038) levels. Conclusion: In maintenance hemodialysis patients, the use of roxadustat is associated with lower serum calcium and iPTH levels.

Key words: font-family:Inter, -apple-system, BlinkMacSystemFont, ", font-size:16px, background-color:#FFFFFF, ">maintenance hemodialysis, roxadustat, calcium-phosphorus metabolism, secondary hyperparathyroidism