Limitations and Strengths
Our meta-analysis has several limitations. First, this study did not
evaluate specific laboratory indicators related to cardiac and renal
function outcomes in the included trials. Second, since the evaluation
of Roxadustat is currently ongoing in Phase II or III clinical trials,
there were inconsistencies in the dosages and observation periods of
Roxadustat among the included studies. Different doses and durations of
Roxadustat may affect the regulation of HIF-α on multiple target genes
to varying degrees, potentially impacting the results of the analysis.
Additionally, our meta-analysis included 16 studies that met the
inclusion criteria, and every included trial being industry-sponsored,
could influence the results of the analysis. Meta-analysis cannot
substitute for adequately powered randomized controlled trials. In spite
of these limitations, this is the first systematic review and
meta-analysis of clinical studies on cardiovascular and renal adverse
events of roxadustat in anemic DD and NDD CKD patients. The
meta-analysis of the 17 trials included in this study revealed that
there were no significant differences in terms of cardiovascular events,
renal-related adverse events, or the risk of progression to ESKD between
the Roxadustat group and the placebo group or ESA group, regardless of
whether dialysis was received or not. However, a higher risk of
hypertension was identified in NDD patients who received oral
Roxadustat, whereas no significant risk of hypertension risk was
detected in DD patients treated with oral Roxadustat.