- Design
- Systematic review and meta-analysis of randomised studies
- Population
- 19 studies, 1,636 adults on peritoneal dialysis
- Primary outcome
- Post-treatment haemoglobin
- Effect
- Mean difference +7.30 g/L (95% CI 5.43 to 9.16), I² 62.6%; low certainty
This meta-analysis pooled 19 randomised studies (1,636 adults on peritoneal dialysis), searched in English and Chinese databases, comparing roxadustat-based regimens with ESA-based regimens for renal anaemia.
Post-treatment haemoglobin was about 7.3 g/L higher with roxadustat (95% CI 5.4 to 9.2), with moderate heterogeneity. Reported adverse events were less frequent (RR 0.45), but definitions varied. Target attainment, iron indices and cardiovascular outcomes could not be reliably assessed. Certainty was low for haemoglobin and low to very low for most other outcomes.
Roxadustat is an oral option that avoids injections, which matters in home-based peritoneal dialysis. But comparator ESA doses varied, final values were pooled rather than changes, and long-term safety data, including cardiovascular and thrombotic events, remain insufficient. This does not establish roxadustat as superior.
- Consider roxadustat as an oral alternative to ESAs in peritoneal dialysis where it is available and injections are a barrier.
- Monitor haemoglobin closely and avoid overshooting targets.
- Watch for thrombotic events, including access and venous thrombosis.
- Check iron status regularly whichever agent is used.
Why it matters
Peritoneal dialysis patients manage treatment at home, where an oral anaemia drug has practical appeal.
Don't overread it
Low-certainty evidence with heterogeneous comparators; long-term safety is not established.
The statistics, in plain English
A 7.3 g/L difference is under 1 g/dL, modest in clinical terms. Because trials compared roxadustat with ESA regimens of varying intensity, some of the difference may reflect under-dosed comparators.
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