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The Cochrane Risk of Bias was used\u00a0for assessment. Meta-analysis evaluated hemoglobin (Hb) increase and cost-effectiveness using the incremental cost-effectiveness ratio.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>From 1298 screened articles, 7 studies were included: 3 prospective studies, 2 randomized open-label non-inferiority trials, and 2 retrospective cohort studies, comprising 208 children for direct comparisons and 357 for transitioning studies. Meta-analysis found no significant Hb improvement differences between rHuEPO and DA after 21\u201328\u00a0weeks of treatment (DA\u2009+\u20090.15\u00a0g\/dL, 95% CI \u2212\u00a00.22 to\u2009+\u20090.52). rHuEPO was more cost-effective than DA. Transitioning to DA increased Hb by\u2009+\u20090.93\u00a0g\/dL (95% CI 0.53\u20131.33) in children with suboptimal levels, after 21\u201328\u00a0weeks of rHuEPO. The incremental cost-effectiveness ratio of switching to DA was\u2009~\u2009\u20ac340 per g\/dL of Hb over 24\u00a0weeks.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>rHuEPO is the most cost-effective initial anemia treatment in pediatric CKD. However, transitioning to DA may be considered for patients who do not achieve adequate Hb response. The small number of randomized controlled trials (RCTs), variability in dose conversion, and study heterogeneity may limit generalizability.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>PROSPERO ID<\/jats:title>\n                    <jats:p>CRD42023460872.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Graphical abstract<\/jats:title>\n                  <\/jats:sec>","DOI":"10.1007\/s40620-025-02303-8","type":"journal-article","created":{"date-parts":[[2025,5,11]],"date-time":"2025-05-11T00:08:35Z","timestamp":1746922115000},"page":"2095-2109","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Comparative efficacy of epoetin alfa vs. darbepoetin in children with chronic kidney disease: a systematic review, meta-analysis and cost-effectiveness analysis"],"prefix":"10.1093","volume":"38","author":[{"ORCID":"https:\/\/orcid.org\/0009-0007-6113-9312","authenticated-orcid":false,"given":"Nicola","family":"Bertazza Partigiani","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alessandro","family":"D\u2019Uva","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Serena","family":"Vigezzi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alessandra Rosalba","family":"Brazzale","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Enrico","family":"Vidal","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2025,5,11]]},"reference":[{"issue":"1","key":"2303_CR1","doi-asserted-by":"publisher","first-page":"48","DOI":"10.2215\/CJN.02080408","volume":"4","author":"AO Staples","year":"2009","unstructured":"Staples AO, Wong CS, Smith JM, Gipson DS, Filler G, Warady BA et al (2009) Anemia and risk of hospitalization in pediatric chronic kidney disease. 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All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest or non-financial interest in the subject matter or materials discussed in this manuscript.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}},{"value":"Ethical approval was not required since no new patients were recruited. The study was a meta-analysis based exclusively on already published data.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval"}},{"value":"Not applicable. The present study is a literature-based meta-analysis.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Research involving human participants and\/or animals"}},{"value":"This systematic review did not involve the collection of new data from participants, and therefore informed consent was not applicable.","order":5,"name":"Ethics","group":{"name":"EthicsHeading","label":"Informed consent to participate"}},{"value":"The data underlying this manuscript are available in the article and in its online supplementary material.","order":6,"name":"Ethics","group":{"name":"EthicsHeading","label":"Data availability statement"}},{"value":"This work is being supported by the Research4Residents project within the Residency Program in Pediatrics at the University of Padova, Italy.","order":7,"name":"Ethics","group":{"name":"EthicsHeading","label":"Funding"}},{"value":"Conceptualization: Bertazza Partigiani Nicola, Vidal Enrico; Methodology: D\u2019Uva Alessandro, Vigezzi Serena, Bertazza Partigiani Nicola; Formal analysis and investigation: Bertazza Partigiani Nicola, Brazzale Alessandra Rosalba; Writing\u2014original draft preparation: D\u2019Uva Alessandro, Vigezzi Serena; Writing\u2014review and editing: Bertazza Partigiani Nicola, Vidal Enrico; Supervision: Vidal Enrico.","order":8,"name":"Ethics","group":{"name":"EthicsHeading","label":"Author contributions"}}]}}