Roxadustat for CKD-related anemia in patients undergoing peritoneal dialysis: a systematic review and meta-analysis

Clinical Snapshot

Key Findings

• P Value: p < 0.00001 for hemoglobin improvement

• Effect Size: Small to moderate clinical effect

• Primary Outcome: Hemoglobin increase of 0.35 g/dL (95% CI 0.28-0.41)

• Nnt Or Sensitivity: Clinically meaningful hemoglobin response likely in majority of treated patients based on confidence interval

• Confidence Interval: 95% CI 0.28-0.41 g/dL for hemoglobin

Clinical Application

Oral administration offers practical advantage over injectable ESAs; requires monitoring of iron parameters and cardiovascular safety Would require TGA approval; potential PBS listing consideration given oral convenience; aligns with ANZDATA registry focus on PD outcomes; relevant to RACGP chronic disease management Australian peritoneal dialysis patients with CKD-related anemia, particularly those intolerant or refractory to erythropoiesis-stimulating agents

Abstract

BACKGROUND: CKD-related anemia remains a major complication in patients receiving peritoneal dialysis (PD), with limited treatment options beyond erythropoiesis-stimulating agents. Roxadustat, an oral hypoxia-inducible factor prolyl hydroxylase inhibitor, has shown promise in correcting CKD-related anemia and modulating iron and metabolic parameters. However, its evidence in PD remains limited. METHODS: We conducted a systematic search of PubMed, Scopus, and Web of Science from inception to July 20, 2025. We included studies reporting the efficacy and safety of roxadustat in PD. Statistical analysis was performed using Review Manager (RevMan 5.4 for Windows) and R Studio. RESULTS: Eight studies were included in the meta-analysis (n = 607). Roxadustat significantly increased hemoglobin at all time points (MD 0.35 g/dL, 95% CI 0.28-0.41; p < 0.00001), serum iron (MD 0.95 µmol/L, 95% CI 0.02-1.89; p = 0.05), and total iron-binding capacity (MD 6.25 µmol/L, 95% CI 3.95-8.55; p < 0.00001), and reduced hepcidin (MD - 12.28 ng/mL, 95% CI - 21.06 to - 3.50; p = 0.006). No significant effects were observed for ferritin (p = 0.49), transferrin saturation (p = 0.45), cholesterol (p = 0.07), LDL (p = 0.14), HDL (p = 0.27), triglycerides (p = 0.26), CRP (p = 0.75), systolic blood pressure (p = 0.10), or diastolic blood pressure (p = 0.08). Heterogeneity was low to moderate for most outcomes. CONCLUSION: Roxadustat is effective in improving hemoglobin and iron metabolism in patients with PD, while exerting neutral effects on lipids, inflammation, and blood pressure. These findings support its role as a promising therapy for CKD-related anemia in PD. CLINICAL TRIAL NUMBER: Not applicable.

References

1. 1.Elkoumi, O., Elkoumi, A., Elbairy, M. K., Mahmoud, M. A. T., & Irfan, H. (2026). Roxadustat for CKD-related anemia in patients undergoing peritoneal dialysis: a systematic review and meta-analysis. BMC Nephrology. https://doi.org/10.1016/j.amjcard.2025.07.010