EFFICACY AND SAFETY OF ROXADUSTAT IN PERITONEAL DIALYSIS–ASSOCIATED ANEMIA: A SYSTEMATIC REVIEW AND META-ANALYSIS

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EFFICACY AND SAFETY OF ROXADUSTAT IN PERITONEAL DIALYSIS–ASSOCIATED ANEMIA: A SYSTEMATIC REVIEW AND META-ANALYSIS

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Co-author 1

Omar Elkoumi omarelkoumi@gmail.com Suez University Faculty of Medicine Suez Egypt *

Co-author 2

Ahmed Elkoumi ahmedelkoumi@yahoo.com The Ministry of Health and Population Health Affairs Directorate of El Sharqeya El Sharqeya Egypt -

Co-author 3

Mariam Khaled Elbairy mariam.ksah@med.suezuni.edu.eg Suez University Faculty of Medicine Suez Egypt -

Co-author 4

Mostafa Adel T. Mahmoud mostafaadeltawfik12@gmail.com Beni Suef University Faculty of Medicine Beni Suef Egypt -

Co-author 5

Hamza Irfan Hamy.khr.hi@gmail.com Shaikh Khalifa Bin Zayed Al Nahyan Medical and Dental College Department of Medicine Lahore Pakistan -

Co-author 6

Ayah Abdulgadir Abdulgadirayah@gmail.com University of Khartoum Faculty of Medicine Khartoum Sudan -

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Co-author 11

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Introduction

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 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. We included studies reporting the efficacy and safety of roxadustat in PD. Statistical analyses were 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), 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 anemia management in PD.

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