Thavarajah S, et al. - Researchers provide an overview of a clinical approach to the use of erythropoiesis-stimulating agents (ESAs) in patients with chronic kidney disease (CKD) and cancer. Generally, clinicians try to maintain Hb levels in the 10- to 11-g/dL range because of the absence of objective advantage of normalizing Hb levels and increased proof of ESA-induced complications in persons with anemia. In 2000, a change was introduced in US Food and Drug Administration oncology guidelines with regard to limitation of ESA use for chemotherapy-induced anemia and the reasons for this were increasing concerns in cancer patients due to associations of ESA use with increased mortality, thrombotic complications, and cerebrovascular accidents. For individuals with CKD and cancer, no guidance was provided. The lowest ESA doses possible that grant a maximum Hb level of 10 g/dL have been recommended for individuals with CKD with remote or active malignancy. Although progression or worsening of outcomes may be seen in some cancers in relation to the use of ESAs, there is a lack of data showing an increased probability of occurrence of new cancers in relation to the use of ESAs in patients on dialysis or earlier stages of CKD.