The erythropoiesis-stimulating agents (ESAs) erythropoietin and darbepoetin 
prevent transfusions among chemotherapy-associated anemia patients. Clinical 
trials, meta-analyses, and guidelines identify mortality, tumor progression, and 
venous thromboembolism (VTE) risks with ESA administration in this setting. 
Product labels advise against administering ESAs with potentially curative 
chemotherapy (United States) or to conduct risk-benefit assessments 
(Europe/Canada). Since 2007, fewer chemotherapy-associated anemia patients in 
the United States and Europe receive ESAs. ESAs and the erythropoietin receptor 
agonist peginesatide prevent transfusions among chronic kidney disease (CKD) 
patients; clinical trials, guidelines, and meta-analyses demonstrate myocardial 
infarction, stroke, VTE, or mortality risks with ESAs targeting high hemoglobin 
levels. U.S. labels recommend administering ESAs or peginesatide at doses 
sufficient to prevent transfusions among dialysis CKD patients. For dialysis CKD 
patients, Canadian and European labels recommend targeting hemoglobin levels of 
10 to 12 g/dL and 11 to 12 g/dL, respectively, with ESAs. ESA utilization for 
dialysis CKD patients has decreased in the United States.