<b>COMPARISON OF ROXADUSTAT AND EPOETIN ALFA IN NON-DIALYSIS DEPENDENT CHRONIC KIDNEY DISEASE PATIENTS</b>

Background: Anemia is a clinically important and prevalent complication of chronic kidney disease (CKD), and its presence is linked to the high morbidity and the poor quality of life thereof. Standard care using erythropoiesis-stimulating agents (ESA) like epoetin alfa contains a number of limitations, and hypoxia-inducible factor prolyl hydroxylase inhibitors like Roxadustat are considered viable options. The study aims include comparing the effectiveness and safety of Roxadustat versus Epoetin alfa in non-dialysis-dependent CKD patients with anemia. Methodology: This randomized controlled trial was conducted in the Nephrology Department of PIMS, Islamabad from 1st January 2025 to 30th May 2025. A total of 132 non-dialysis CKD patients were enrolled and equally divided into two groups: Roxadustat (n=66) and epoetin alfa (n=66). Patients were followed for six months with assessments at baseline, 1 and 3 months. The primary outcome was achievement of target hemoglobin (10–12 g/dL), while secondary outcomes included blood transfusion requirement, major adverse cardiovascular events (MACE), and mortality. Data were analyzed using SPSS version 25. Results: Both groups showed comparable improvement in hemoglobin and ferritin levels at 3 months, with no statistically significant difference (p>0.05). Target hemoglobin was achieved in 42.4% of patients in the Roxadustat group compared to 34.8% in the epoetin alfa group (p=0.371). A significantly lower proportion of patients in the Roxadustat group required blood transfusion (4.5% vs. 15.2%, p=0.041). No significant differences were observed in MACE (p=0.511) or mortality (p=1.000). Stratification analysis showed that reduced transfusion requirement with Roxadustat was particularly evident among males and patients aged ≥60 years. Conclusion:  Roxadustat showed better efficacy in reaching target hemoglobin as compared to epoetin alfa, although difference wasn’t significant. On the other hand, a statistically significant decrease in blood transfusion was noted but the risk of MACE or mortality found nearly similar. Such observations advocate its decent applicability in the management of anemia among non-dialysis CKD patients.