Anemia in chronic kidney disease is a prevalent and expensive problem in the 
United States, and it is well documented that anemia worsens as glomerular 
filtration rates decline. The complications of severe anemia in this patient 
population contribute significantly to their overall morbidity with increased 
cardiovascular complications, decreased quality of life, and increased 
dependence on transfusions to maintain adequate hemoglobin levels. 
Erythropoietin-stimulating agents (ESAs) have revolutionized the treatment of 
anemia in this population, but there has been a great deal of controversy 
surrounding the quest for the ideal hemoglobin target. In addition, there are 
economic and practice management implications where anemia treatment is 
concerned, with ongoing refinement of Centers for Medicare and Medicaid 
Services-bundled payments. One of the newest additions to the arsenal used to 
fight anemia in end-stage renal disease patients is peginesatide (Omontys), a 
synthetic, PEGylated, peptide-based ESA that acts by stimulating the 
erythropoietin receptor. The role of peginesatide in the future treatment of 
anemia in chronic kidney disease remains uncertain, with new safety concerns 
being brought to attention as it emerges on the market, prompting a national 
recall.