Chronic kidney disease (CKD) affects almost 40 million people in the United States. The condition can cause a variety of health complications, including anemia. Treatments for anemia of CKD consist of erythropoiesis-stimulating agents (ESAs), the first of which the FDA approved in 1989. But a new kind of drug is poised to shake up the class, with the first expected approval potentially happening later this year.

When people’s kidneys are healthy, they produce erythropoietin, a product that prompts the bone marrow to make red blood cells. When the kidneys are damaged, their erythropoietin production goes down, causing a decline in red blood cells, which in turn causes anemia.

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