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Kidney Week

Abstract: TH-PO977

Evaluating the Outcomes of Roxadustat Treatment for Anemia in Dialysis-Dependent CKD: A Systematic Review and Meta-Analysis

Session Information

Category: Anemia and Iron Metabolism

  • 200 Anemia and Iron Metabolism

Authors

  • Elfaituri, Muhammed Khaled Elhadi, University of Tripoli Faculty of Medicine, Tripoli, Libya
  • Elfaituri, Taha Khaled, University of Tripoli Faculty of Medicine, Tripoli, Libya
  • Faraj, Hazem, University of Tripoli Faculty of Medicine, Tripoli, Libya
  • Msherghi, Ahmed, University of Tripoli Faculty of Medicine, Tripoli, Libya
Background

Chronic kidney disease (CKD) patients often grapple with anemia, a complication that severely impinges on their quality of life and overall prognosis. Roxadustat, an innovative oral hypoxia-inducible factor prolyl hydroxylase inhibitor, has emerged as a potential solution to this pervasive issue. However, its effectiveness and safety need to be comprehensively analyzed. This study aims to investigate the efficacy and safety of Roxadustat for anemia in CKD patients.

Methods

We systematically searched PubMed, Web of Science, and Cochrane Library databases until October 2022. We sought randomized controlled trials (RCTs) that compared Roxadustat with Epoetin Alfa or a placebo in dialysis-dependent CKD patients. The primary outcomes were changes from baseline in hemoglobin, hepcidin, ferritin, and transferrin saturation (TSAT) levels. Secondary outcomes were the incidence of adverse and major adverse events. The data were aggregated using a random-effects model and expressed as standardized mean differences (SMDs) for continuous outcomes or relative risks (RRs) for dichotomous outcomes. The meta-analysis was executed using R version 4.0.3, employing the metafor and meta packages.

Results

We included five studies comprising 3,478 participants (1,847 administered Roxadustat and 1,631 given Epoetin Alfa or a placebo). Roxadustat was found to significantly enhance hemoglobin (SMD: 0.32, 95% CI: 0.12-0.52, p < 0.01, I2=39%) and lower hepcidin levels (SMD: -0.29, 95% CI: -0.45- -0.14, p < 0.01, I2=23%) from baseline, as compared to the control group. However, changes in ferritin (SMD: 0.03, 95% CI: -0.17-0.24, p = 0.76, I2=0%) and TSAT levels (SMD: 0.14, 95% CI: -0.07-0.34, p = 0.19, I2=0%) were not statistically significant. Adverse events (RR: 1.02, 95% CI: .96-1.07, p = 0.5, I2=33%) and major/critical adverse events (RR: 1.05, 95% CI: 0.96-1.16, p = 0.3, I2=20%) were marginally more frequent in the Roxadustat group, but these differences lacked statistical significance.

Conclusion

Roxadustat may potentially elevate hemoglobin and decrease hepcidin levels in dialysis-dependent CKD patients. However, its effects on ferritin and TSAT levels are unclear. Future, more extensive studies are needed to validate these findings and determine Roxadustat's optimal use.