Stirnadel-Farrant HA, et al. - Researchers analyzed the erythropoiesis-stimulating agent (ESA) use patterns, characteristics, and outcomes of ESA-treated/untreated patients in the setting of pre-dialysis chronic kidney disease (CKD) patients. They aggregated electronic healthcare records and medical claims data from a large US managed care provider (2011–13). They reported an exceedingly rare use of ESA in pre-dialysis CKD patients. Furthermore, ESA use in these patients was directed disproportionately to older, sicker patients; high rates of death and cardiovascular events were observed in these patients. A context for contemporary use of ESA in pre-dialysis CKD was offered by these findings.