Research Paper Volume 13, Issue 13 pp 17914—17929

Roxadustat for the treatment of anemia in patients with chronic kidney diseases: a meta-analysis

Li Zhang1, , Jie Hou1, , Jia Li1, , Sen-Sen Su1, , Shuai Xue2, ,

  • 1 Department of Nephrology, The First Hospital of Jilin University, Jilin Province, China
  • 2 Department of Thyroid Surgery, The First Hospital of Jilin University, Jilin Province, China

Received: January 22, 2021       Accepted: May 17, 2021       Published: June 11, 2021
How to Cite

Copyright: © 2021 Zhang et al. This is an open access article distributed under the terms of the Creative Commons Attribution License (CC BY 3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.


Background: Anemia is a common complication of chronic kidney disease (CKD). Treating renal anemia with erythropoiesis-stimulating agents (ESAs) or erythropoietin analogs is effective but has side effects. Therefore, we performed a meta-analysis to assess the efficacy and safety of roxadustat in treating CKD-induced anemia.

Methods: We searched publications online and conducted a meta-analysis and calculated relative risks with 95% confidence intervals (CIs) for dichotomous data and mean differences (MD) with 95% CIs for continuous data.

Results: Of 110 articles, nine were included that contained 12 data sets and 11 randomized control trials on roxadustat. In the non-dialysis-dependent (NDD) high-dose/low-dose subgroups, the change in hemoglobin (Hb) levels was significantly higher in the roxadustat group than in the placebo group (P<0.0001, P=0.001, respectively). The Hb response rate of the roxadustat is higher in the NDD subgroup than in the placebo group (P<0.00001, MD=6.92, 95% CI: 4.03, 11.89). However, in the dialysis-dependent subgroup, there was no significant difference in the change in Hb levels or the Hb response rate between the roxadustat and ESA groups. There was no change in the mortality in the roxadustat group compared to that in the placebo/ESA group. Hyperkalemia may be a side effect of roxadustat.

Conclusions: Roxadustat elevated the serum Hb levels in a manner similar to that observed for ESAs. Roxadustat raised the Hb levels more significantly than the placebo and showed a higher Hb response rate than the placebo group in NDD patients. Roxadustat is a safe and effective drug for anemia in CKD patients.


CKD: chronic kidney disease; DD: dialysis dependent; ESA: erythropoiesis -stimulating agents; EPO: Erythropoietin; HIFs: Hypoxia-inducible factors; HIF-PHs: HIF-prolyl hydroxylase; MeSH: Medical Subject Headings; NDD: Non dialysis -dependent; RCT: Randomized Controlled Trial; BP: diastolic blood pressure; RBC: red blood cell; HD: Hemodialysis; PD: peritoneal dialysis; RevMan: Review Manager; RRs: Relative risks; CIs: confidence intervals; MDs: mean differences; IV: Intravenous.