Anemia has remained one of the most characteristic and visible manifestations of
chronic renal failure for over 150 years. The pathogenesis of
anemia of
chronic kidney disease (CKD) is multifactorial with inadequate production of
erythropoietin being the leading factor. The development of recombinant human
erythropoietin (epoetin) in the late 1980s was a milestone in treatment of renal
anemia. Despite new drugs, our 'good old friend'
erythropoietin-stimulating agents are our everyday life in nephrology practice. It seems that
peginesatide would not become a new approach for treating
anemia of CKD patients, but rather a falling star. Several new strategies for treating the
anemia of CKD are currently being investigated in clinical trials, including
prolyl hydroxylase inhibitors and modulators of
hepcidin activity, but their role in the management of this condition remains to be established. As shown by the expert in this review, we have to take into account not only the safety and convenience of administration but also cost-effectiveness, while
biosimilars are consequently knocking at the doors of dialysis units more and more, particularly in Europe.