Erythropoiesis stimulating agents (ESAs) have revolutionized the management of 
anemia of chronic kidney disease (CKD). Peginesatide is an investigational 
pegylated, peptide-based, once-monthly ESA for increasing and maintaining 
hemoglobin (Hb). In phase 2 studies, peginesatide increases and maintains target 
Hb levels in patients with CKD, both those on hemodialysis and those not on 
hemodialysis; phase 3 trials have recently been completed. This article 
discusses unmet needs in the management of anemia of CKD, presents peginesatide 
attributes, reviews the results of select peginesatide clinical studies, and 
discusses the potential value of peginesatide as an alternative anemia 
management option.