Drug-Induced Liver Failure in an Elderly Patient Attributed to Roxadustat: A Case Report

Abstract Background: Roxadustat is a pharmacological agent categorized as a prolyl hydroxylase inhibitor. By inhibiting prolyl hydroxylase, it reduces the degradation of hypoxia-inducible factors, thereby enhancing erythropoiesis. Roxadustat is currently widely employed in clinical settings for the treatment of renal anemia. Research conducted both domestically and internationally has identified a range of adverse reactions associated with its therapeutic use, primarily including hypothyroidism, rhabdomyolysis, and alterations in serum iron and copper levels. Although the potential for hepatotoxicity has been recognized, the existing literature provides limited information regarding such adverse effects. Case presentation: A 93-year-old male patient with chronic kidney disease, complicated by anemia, experienced hepatic failure following the initiation of treatment with roxadustat. Upon discontinuation of roxadustat, the patient received bilirubin adsorption(BA) and continuous renal replacement therapy(CRRT), among other interventions, and subsequently returned to normal health. Conclusions: This study presents the first documented case of roxadustat-induced hepatic failure in an elderly patient. Despite the low incidence of hepatic injury among reported adverse reactions, we recommend vigilant monitoring of hepatic function in elderly patients receiving roxadustat, with prompt discontinuation of the drug if adverse reactions occur.