Roxadustat for CKD-related anemia in patients undergoing peritoneal dialysis: a systematic review and meta-analysis

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.