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Abstract: TH-PO684

Effects of Hypoxia-Inducible Factor-Prolyl Hydroxylase Inhibitors vs. Erythropoiesis-Stimulating Agents on Iron Metabolism in Non-Dialysis-Dependent Anemic Patients With CKD: A Network Meta-Analysis

Session Information

  • Anemia and Iron Metabolism
    November 03, 2022 | Location: Exhibit Hall, Orange County Convention Center‚ West Building
    Abstract Time: 10:00 AM - 12:00 PM

Category: Anemia and Iron Metabolism

  • 200 Anemia and Iron Metabolism


  • Yang, Junlan, Institute of Nephrology / Southeast University School of Medicine / Zhong Da Hospital, Nanjing, China

Group or Team Name

  • Institute of Nephrology / Southeast University School of Medicine / Zhong Da Hospital

Hypoxia-inducible factor- prolyl hydroxylase inhibitors (HIF-PHIs) are an emerging drug for the treatment of renal anemia, which has not yet been used in clinical practice. Although many clinical studies have proved that the ability of HIF-PHIs to treat anemia is equivalent to erythropoiesis-stimulating agents (ESAs), the mechanisms of hemoglobin production of the two drugs are different. We performed this network meta-analysis to compare the effects of HIF-PHIs, ESA, and placebo on iron regulation in patients with renal anemia who do not receive dialysis.


The Cochrane Library, PubMed, Web of Science, CNKI, WANGFANG DATA were used for search in documents and journals ranging from January 1946 to December 2021. The literatures with respect to the randomized controlled clinical trial comparing HIF-PHIs, ESAs, and placebo in non-dialysis-dependent anemic patients with chronic kidney disease were selected.The main outcomes were the change in hepcidin and hemoglobin (Hb) levels.


Of 1589 original titles screened, data was extracted from 15 studies included a total of 3238 patients (Fig. 1). The league table shows pairwise comparisons of the effectiveness of hepcidin-lowering and hemoglobin-raising among the eight interventions (Fig. 2). Compared with placebo, Enarodustat (SMD = –1.52, 95% CI: –3.01 to –0.03), and Roxadustat (SMD = –1.29, 95% CI: –2.23 to –0.35) could significantly reduce the level of hepcidin. All HIF-PHIs and ESAs showed greater ability to increase Hb levels than placebo, and there was no significant difference between HIF-PHIs and ESAs.


HIF-PHIs and ESAs have different effects on iron regulation in non-dialysis-dependent anemic patients with CKD, indicating that HIF-PHIs may increase Hb levels by promoting iron mobilization.

Fig. 1. Characteristics of included studies

Fig. 2. The league table


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