In a multicenter, prospective, observational study of 279 kidney transplant recipients with anemia, the efficacy and safety of once-monthly continuous erythropoietin receptor activator (C.E.R.A.) were assessed to a maximum of 15 months. The main efficacy variable was the proportion of patients achieving a hemoglobin level of 11-12？g/dL at each of visits between months 7 and 9. At study entry, 224 patients (80.3%) were receiving erythropoiesis stimulating agent (ESA) therapy including darbepoetin alfa (98), epoetin beta (61), and C.E.R.A. (45). The mean (SD) time between C.E.R.A. applications was 34.0 (11.9) days. Among 193 patients for whom efficacy data were available, mean (SD) hemoglobin was 11.1 (0.99)？g/dL at study entry, 11.5 (1.1)？g/dL at month 7, 11.6 (1.3)？g/dL at month 9, and 11.4 (1.1)？g/dL at month 15. During months 7–9, 20.7% of patients had all hemoglobin values within the range 11-12？g/dL and 64.8% were within 10–13？g/dL. Seven patients (2.5%) discontinued C.E.R.A. due to adverse events or serious adverse events. In this observational trial under real-life conditions, once-monthly C.E.R.A. therapy achieved stable hemoglobin levels in stable kidney transplant recipients with good tolerability, and with no requirement for any dose change in 43% of patients. 1. Introduction Anemia is virtually universal at the time of kidney transplantation [1]. Chronic kidney disease (CKD) blunts erythropoietin production [2], a proanemic effect that is compounded by other factors such as accelerated erythrocyte destruction and widespread use of concomitant medication such as ACE inhibitors and ARBs [3]. Following transplantation, the prevalence of anemia declines sharply as renal function is restored but low hemoglobin (Hb) levels persist in a worryingly large proportion of cases due to multiple factors such as suboptimal renal function, cardiovascular medication, and certain immunosuppressive therapies [4, 5]. In the largest series to date, an analysis of 5,834 kidney transplant recipients at 10 European outpatient transplant clinics detected anemia in 42% of patients based on the American Society of Transplantation anemia guidelines ( ？g/dL in males and ≤ 12.0？g/dL in females) [6]. Using the same thresholds, large single-center cohort studies have found that 30–35% of kidney transplant patients have anemia [7–9]. In nontransplant CKD populations, anemia is predictive of cardiovascular events [10], mortality [11, 12], and diminished quality of life [13]. Posttransplant anemia is significantly associated with increased death-censored [14, 15] and all-cause
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