Abstract
•ESA are commonly used to treat anemia in chronic kidney disease but meet several limits. Iron needs are elevated and cardio-vascular mortality may increase at high-dose. •Prolyl-hydroxylase domain is involved in hypoxia physiology and its inhibition leads to higher hemoglobin and lower hepcidin levels, decreasing iron needs. Oral PHD inhibitors will be soon available to treat CKD related anemia. •Many pathways are affected by PHD inhibition and data are lacking regarding their long term safety. For these reasons, longer studies are needed before using PHDi in clinical practice.
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