Renal anemia is a common complication of chronic kidney disease. The primary goal of treatment of renal anemia is to increase and maintain hemoglobin levels and reduce the risk of complications of chronic hypoxia, higher mortality rates, and cardiovascular disease. Renal anemia nondialysis patients are initially treated with oral iron, followed by IV iron; ESAs are prescribed as third-line therapy. Dialysis patients usually receive IV iron therapy followed by ESAs. Several ESAs and iron supplements are available and have had varying degrees of commercial success. Key approved agents include Amgen’s Epogen, Janssen’s Procrit, Pfizer’s Retacrit, Amgen’s Aranesp, Roche / Chugai’s Mircera, and Keryx’s Auryxia. This report provides important insights into how these agents are used to manage renal anemia and how practice is evolving.