Systematic review and meta-analysis finds roxadustat improves hemoglobin in peritoneal dialysis patients

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BMC nephrology Published May 27, 2026 Medically reviewed May 27, 2026 Study authors: Elkoumi Omar, Elkoumi Ahmed, Elbairy Mariam Khaled, Mahmoud Mostafa Adel T, Irfan Hamza PubMed ↗ DOI ↗ By Dr. Amelia Tan, PhD · Internal Medicine & Chronic Disease

Key Takeaway

Consider roxadustat for anemia in peritoneal dialysis, but evidence remains limited.

This systematic review and meta-analysis evaluated the efficacy of roxadustat for CKD-related anemia in patients receiving peritoneal dialysis (PD). The analysis included 607 patients from available studies, though the comparator was not reported. The primary outcome was hemoglobin, with multiple secondary outcomes including iron parameters, lipids, and blood pressure.

Roxadustat significantly increased hemoglobin (mean difference 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) also increased significantly. Hepcidin levels were reduced (MD -12.28 ng/mL, 95% CI -21.06 to -3.50; p = 0.006). No significant effects were observed for ferritin, transferrin saturation, cholesterol, LDL, HDL, triglycerides, CRP, or blood pressure.

The authors note that evidence in PD remains limited. Adverse events, serious adverse events, and discontinuations were not reported. The findings support roxadustat as a promising therapy for CKD-related anemia in PD, but cautious interpretation is warranted given the limited evidence base.

Study Details

Study typeMeta analysis

EvidenceLevel 1

PublishedMay 2026

PMID42185813

View Original Abstract ↓

BACKGROUND: CKD-related 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 CKD-related 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 from inception to July 20, 2025. We included studies reporting the efficacy and safety of roxadustat in PD. Statistical analysis was 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), HDL (p = 0.27), 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 CKD-related anemia in PD. CLINICAL TRIAL NUMBER: Not applicable.