Erythropoiesis stimulating agents (ESAs) are effective drugs that correct
anemia in patients with
chronic kidney disease (CKD). Recombinant human
erythropoietin (EPO), the first ESA that became available more than 20 years ago, is similar to the naturally occurring molecule. In subsequent years, pharmacological research focused on the development of new agents with improved characteristics, with the creation of high molecular weight ESAs having been the first approach. In more recent years, new agents have been developed, including
peginesatide (
Hematide; Affymax Inc/Takeda
Pharmaceutical Co Ltd), which is a dimeric
peptide with a chemical structure unrelated to EPO that is being evaluated in phase III clinical trials. In addition, the clinical development of two inhibitors of
hypoxia-inducible
transcription factor has been resumed recently, while other approaches, such as gene therapy and EPO fusion
proteins, and the inhibition of GATA and
hematopoietic cell phosphatase remain far from being applicable in clinical practice. New
iron compounds, which are becoming increasingly available, will facilitate an integrated approach to
anemia management using both
iron and/or ESAs, according to the clinical needs of patients. This review discusses new therapeutic options (already available or still under development) for the treatment of CKD-associated
anemia, including ESAs and intravenous
iron molecules.