Erythropoiesis stimulating agents (ESAs) are the standard of care for anaemia in CKD patients. They have significantly changed treatment by avoiding blood transfusions and improving outcomes and quality of life. However, their use is limited by the need for parenteral administration and by hypo-responsiveness in several patients.

Hypoxia-inducible factor-prolyl hydroxylase domain inhibitors are novel anti-anaemic drugs developed for oral therapy of CKD-related anaemia. They have a unique mechanism of action, and may be possibly also effective in patients hyporesponsive to ESA.

The results of Phase 3 studies with HIF-PHIs have demonstrated efficacy and safety not dissimilar from present ESAs. Additional positive or negative effects need to be proven with larger cohorts and longer-term use of these drugs.