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.