Efficacy and safety of prolyl hydroxylase inhibitors for anemia in chronic kidney disease: a network meta-analysis.
Yuanchen Niu, Tenghua Wang, Yaoxuan Zhan et al.
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In 30 seconds
This Bayesian network meta-analysis compared six prolyl hydroxylase inhibitors (PHIs) with erythropoiesis-stimulating agents (ESAs) or placebo for anemia in chronic kidney disease. It included 46 randomized controlled trials with 32,305 patients, assessed separately in non-dialysis and dialysis CKD. Roxadustat ranked highest for hemoglobin improvement in both groups: mean difference 1.21 g/dL (95% CI: 0.72-1.71) in non-dialysis CKD and 1.78 g/dL (95% CI: 1.32-2.24) in dialysis CKD. Safety rankings differed: ESA had the lowest adverse-event risk in non-dialysis CKD, while roxadustat showed higher adverse-event incidence.
Key findings
- In non-dialysis CKD, roxadustat had the greatest hemoglobin rise: MD = 1.21 g/dL, 95% CI: 0.72-1.71; SUCRA = 88.6%.
- In dialysis CKD, roxadustat ranked highest for hemoglobin improvement: MD = 1.78 g/dL, 95% CI: 1.32-2.24; SUCRA = 86.2%.
- In non-dialysis CKD, ESA had the lowest adverse-event risk (OR = 0.85, 95% CI: 0.74-0.98); roxadustat ranked lowest for safety (SUCRA = 18.4%).
- ESA ranked best for TSAT in non-dialysis CKD (MD = 5.24%, 95% CI: 1.16-9.32), while daprodustat led in dialysis CKD (MD = 3.07%, 95% CI: 0.22-5.91).
Why it matters
The findings show that comparative performance varies by outcome and dialysis status: the agent with the strongest hemoglobin response was not necessarily the safest or best for iron indices. This distinction is relevant when weighing anemia correction against adverse events and iron metabolism, while recognizing that the estimates come from comparisons synthesized across trials.
What to keep in mind
The findings are based on a network meta-analysis, so some treatment comparisons rely on indirect evidence; the abstract does not report follow-up duration or detailed adverse-event types.