Impact of C-reactive protein on the effect of Roxadustat for the treatment of anemia in chronic kidney disease: a systematic review of randomized controlled trials

Table 2 Certainty of evidence and summary effect estimates assessed by GRADE (grading of recommendations, assessment, development, and evaluation) of the study outcomes

Outcomes	Summary of findings		Quality assessment					Certainty of evidence	Importance
Outcomes	No. of participants (studies)	MD (95%CI)	Study design	Inconsistency	Indirectness	Imprecision	Other consideration	Certainty of evidence	Importance
ΔHb compared between CRP ≥ ULN and CRP	524 (4 RCTs)	MD 0.00 [-0.32,0.33]	Very serious ^{a, b2}	not serious	not serious	not serious	none	⨁⨁◯◯ Low	CRITICAL
ΔHb in CRP ≥ ULN compared between HIF-PHI and control	1399 (3 RCTs)	MD 0.24 [-0.08,0.56]	Very serious ^{b, c, d}	very serious ^e	not serious	not serious	none	⨁◯◯◯ Very low	CRITICAL

MD mean difference, CI confidence interval
GRADE Working Group grades of evidence
High quality: very confident that the true effect lies close to that of the estimate of the effect
Moderate quality: moderately confident in the effect estimate, and the true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different
Low quality: confidence in the effect estimate is limited, and the true effect could be substantially different from the estimate of the effect
Very low quality: very little confidence in the effect estimate, and the true effect is likely to be substantially different from the estimate of effect
Explanations
^aThree of the four studies were open-label
^bAll studies are sponsored by the enterprise
^cAll studies are open-label
^dAll studies have a high rate of loss of follow-up
^eThe I2 statistic is considerable and adjustment according to previous ES A treatment still failed to resolve inter- and intra-group heterogeneity

ISSN: 1471-2369