Optimizing the management of renal anemia: challenges and new opportunities.

Erythropoiesis stimulating agents (ESAs) are the main tool to achieve anemia correction in CKD patients. At present six different ESAs are available: epoetin alpha, epoetin beta, epoetin omega, epoetin delta, darbepoetin alpha, and very recently CERA. From one side the patent of older ESAs have expired, and biosimilars (for the moment only of epoetin alpha) have been approved for use in Europe by the European Medicines Agency. However, a number of issues about bioequivalence and how to test it are still to be solved completely. In the mean time pharmaceutical research has kept on working, developing new ESAs and alternative strategies for stimulating erythropoiesis. In this review we present and discuss these points.