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The introduction of erythropoiesis-stimulating agents (ESAs) revolutionized the management of anaemia in chronic kidney disease (CKD) patients by providing effective control of haemoglobin (Hb) levels, reducing the need for blood transfusions and improving patient quality of life. The use of ESAs in CKD patients is constantly evolving as new research helps us to better understand how to safely and effectively manage anaemia in these patients. This supplement reviews the latest thinking on optimal Hb control and looks to the future in the increasingly complex landscape of ESA therapies. Anaemia has been recognized as a risk factor for the development of cardiovascular disease (CVD) in CKD patients and CVD remains the leading cause of hospitalization and death in these patients. In their chapter entitled ‘Future perspectives on treatment with erythropoiesis stimulating agents’ in high-risk patients, Stefan Anker and Robert Toto review several large-scale clinical studies designed to address the question of whether effective management of anaemia can improve cardiovascular (CV) outcomes. Results of the CHOIR [1] and CREATE [2] studies are discussed, along with two more recent studies, TREAT (Trial to Reduce cardiovascular Events with Aranesp Therapy) [3,4] and the RED-HF (Reduction of Events with Darbepoetin alfa in Heart Failure) trial [5], which are currently ongoing. The latter randomized controlled studies are anticipated to shed light on ESA safety at higher target Hb levels and it is hoped that they will provide the conclusive data still needed to establish the impact of anaemia therapy on CVD in these patients.

Key insights into present and future treatments of anaemia in CKD patients