Systematic review and meta-analysis finds roxadustat improves hemoglobin in peritoneal dialysis patientsRoxadustat Boosts Hemoglobin in Peritoneal Dialysis Patients

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

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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.

A new analysis of studies on roxadustat, a drug for anemia related to chronic kidney disease (CKD), shows it can help people on peritoneal dialysis. The review combined data from 607 patients and found that roxadustat significantly increased hemoglobin levels by an average of 0.35 g/dL. It also boosted serum iron and total iron-binding capacity, and reduced hepcidin, a hormone that can block iron use.

Other measures like ferritin, transferrin saturation, cholesterol, and blood pressure did not change significantly. The drug was studied in patients receiving peritoneal dialysis, a type of dialysis done at home. The review did not report on side effects or how well patients tolerated the treatment.

Because the evidence is still limited, these findings should be seen as promising but not definitive. More research is needed to confirm the benefits and understand the risks. For now, roxadustat appears to be a helpful option for managing anemia in this group, but patients should discuss it with their healthcare team.

What this means for you:

Roxadustat may improve anemia in peritoneal dialysis patients, but more research is needed.

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.

Systematic review and meta-analysis finds roxadustat improves hemoglobin in peritoneal dialysis patientsRoxadustat Boosts Hemoglobin in Peritoneal Dialysis Patients

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Systematic review and meta-analysis finds roxadustat improves hemoglobin in peritoneal dialysis patientsRoxadustat Boosts Hemoglobin in Peritoneal Dialysis Patients

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