Efficacy and safety analysis of different treatment schemes of erythropoiesis-stimulating agents for chronic kidney disease with anemia: a meta analysis between 2000-2024.

OBJECTIVE: This study aims to evaluate the efficacy and safety of different regimens of erythropoiesis-stimulating agents (ESAs) in the treatment of anemia associated with chronic kidney disease. The regimens analyzed include a low-frequency high-dose epoetin group, a high-frequency low-dose epoetin group, and a Darbepoetin group. METHODS: A comprehensive search was conducted across several databases, including the China National Knowledge Infrastructure (CNKI), Wanfang Database, China Biology Medicine disc (CBM), PubMed, Web of Science, and Embase. We focused on randomized controlled trials (RCTs) related to ESA treatment for renal anemia published between January 1, 2000, and August 31, 2024. Data were extracted from studies meeting the inclusion criteria, and the Cochrane risk of bias assessment tool was employed for analysis. A meta-analysis of hemoglobin levels and adverse events was performed using RevMan 5.4. RESULTS: Twenty-eight studies were included in this review. Of these, 22 studies analyzed the frequency and efficacy of various dosage forms of short-acting ESAs, encompassing 1,670 patients with renal anemia. Additionally, 6 studies comprising 282 patients evaluated the efficacy and safety of Darbepoetin compared to high-frequency low-dose short-acting ESAs. The efficacy analysis revealed no statistically significant differences in hemoglobin level increases between the low-frequency high-dose group and the high-frequency low-dose group of epoetin [MD = 1.38, 95% CI (−0.64, 3.40), Z = 1.34, p > 0.05], nor between the Darbepoetin and short-acting ESA groups [MD = 0.23, 95% CI (−0.16, 0.62), Z = 1.16, p > 0.05]. In terms of safety, there were also no statistically significant differences between the low-frequency high-dose group and the high-frequency low-dose group [MD = 1.30, 95% CI (0.98, 1.73), Z = 1.82, p > 0.05]; however, the Darbepoetin group demonstrated a superior safety profile compared to the short-acting ESA group [MD = 0.63, 95% CI (0.41, 0.97), Z = 2.09, p < 0.05]. CONCLUSION: The results indicate no significant difference in efficacy and safety between the low-frequency and high-frequency groups. Nevertheless, the low-frequency administration of erythropoietin (Darbepoetin) resulted in fewer adverse reactions, potentially improving patient compliance. CLINICAL TRIAL NUMBER: Not applicable.