Abstract: 【Abstract】Objective To compare the efficacy and safety of hypoxia-inducible factor prolyl hydroxylase inhibitors(HIF-PHIs) and erythropoiesis-stimulating agents (ESAs) in the treatment of renal anemia in dialysis-dependent chronic kidney disease (CKD) patients by meta-analysis. Methods We searched the databases of PubMed, Embase, Cochrane library from inception until 15th September, 2020 for randomized controlled trials of HIF-PHIs and ESAs for the treatment of renal anemia in dialysis-dependent CKD patients. Their hemoglobin(Hb) level, iron metabolism parameters and adverse reactions were extracted and analyzed by the
software of Review Manager Version 5.3. Results Eight studies comprising a total of 1,512 dialysis-dependent CKD patients with anemia were included in the analysis. No significant differences were found between HIF-PHIs group and ESAs group in terms of hemoglobin level (MD=-0.15, 95% CI: -0.35, 0.05; P=0.14), ferritin level (MD=14.61, 95% CI: -3.80, 33.02, P=0.12) and hepcidin level (MD=-16.46, 95% CI: -37.77, 4.85; P=0.13). However, HIF-PHIs group showed better efficacies in terms of transferrin level (MD=0.27, 95% CI: 0.08, 0.46; P=0.02), serum iron level (MD=3.29, 95% CI: 1.22, 5.37; P＜0.01) and transferrin saturation
(MD=4.15, 95% CI: 3.88, 4.42; P＜0.01) as compared with those in ESAs group. There were no differences in adverse reactions between the two groups (OR=1.31, 95% CI: 0.99, 1.74; P=0.06), except the higher nausea rate (OR=1.85, 95% CI: 1.05, 3.27; P=0.03) in HIF-PHIs group than in ESAs group. Conclusion The meta analysis found that the effect and safety of HIF-PHIs were similar to those of ESAs in the treatment of renal anemia in dialysis-dependent CKD patients.

Key words: Hypoxia-inducible factor prolyl hydroxylase inhibitor, Erythropoiesis-stimulating agent, Dialysis-dependent, Anemia, Meta-analysis