Anemia is a common complication of chronic renal insufficiency, one that leads to a reduced quality of life and an increased burden on the heart. In recent years, it has been shown that anemia is underrecognized and undertreated in these patients. The benefits of recombinant human erythropoietin treatment in this patient population have been well shown. The major side effect, hypertension, is particularly important in chronic renal insufficiency, requiring careful monitoring. In this review, the benefits of anemia therapy are weighed against the risks and costs. On balance, it is concluded that anemia treatment meets a basic and important health need in these patients.