Erythropoietin stimulating agents (also called ESA medicines) are used to treat anemia caused by chronic kidney disease.

The kidneys make a hormone called erythropoietin. This helps the body make red blood cells. If your kidneys do not make enough of the hormone, you can get anemia. This can make you feel weak and tired. ESAs replace the hormone.

ESA is usually injected under the skin. It can be injected into a vein.


  • Darbepoetin alfa (Aranesp)
  • Epoetin alfa (Eprex)

Possible side effects

Side effects may include:

  • High blood pressure.
  • Having too many red blood cells. This may raise your risk for heart failure, heart attack, and stroke.
  • Deep vein thrombosis. This is a blood clot in a vein. A clot can be deadly if it travels to a lung.
  • Seizure.
  • A blood clot in a dialysis access.

Most people do not have side effects.

You may have other side effects or reactions not listed here. Check the information that comes with your medicine.

What to know about taking these medicines

  • ESA medicines can help you feel better.
  • They can improve your appetite and energy.
  • They may delay the need for dialysis.
  • You may need fewer blood transfusions.
  • ESAs cost a lot. Ask your doctor to help you find the dose that works best for you at the least cost.
  • Take your medicines exactly as prescribed. Call your doctor or nurse call line if you think you are having a problem with your medicine.
  • Tell your doctor or pharmacist all the medicines you take. This includes over-the-counter drugs and natural health products. Taking some medicines together can cause problems.
  • Make sure you see your doctor for blood tests. These tests help your doctor keep track of your red blood cell count.