BackgroundRoxadustat is an oral hypoxia-inducible factor prolyl hydroxylase inhibitor used to treat anemia in patients with chronic kidney disease (CKD); however, evidence from randomized trials has not fully clarified its associations with thrombotic outcomes and all-cause mortality.MethodsWe searched PubMed, Embase, Web of Science, and the Cochrane Library from inception to 21 August 2025 for randomized controlled trials comparing roxadustat with placebo or erythropoiesis-stimulating agents (E