Anemia is a common complication in chronic kidney disease (CKD) and significantly impacts patients' quality of life and clinical outcomes. The pathophysiology of anemia in CKD involves multiple factors, including erythropoietin (EPO) deficiency, iron dysregulation, chronic inflammation, bone marrow dysfunction, and nutritional deficiencies. Despite advances in understanding this condition, anemia remains a significant clinical challenge in CKD patients. Guidelines aim to standardize the diagnosis and treatment of anemia, but recommendations vary between publications. Recent studies suggest that novel biomarkers may help evaluate anemia and related conditions like iron deficiency in CKD patients. This review summarizes the pathophysiology, diagnosis, and management of anemia in CKD, including novel therapeutic approaches such as hypoxia-inducible factor-prolyl hydroxylase inhibitors (HIF-PHIs). Understanding these complex mechanisms is crucial for effective diagnosis and treatment of anemia in CKD patients. Anemia in CKD is not only a marker of disease severity but also a predictor of adverse outcomes, including cardiovascular events and mortality. It is also associated with worse quality of life and increased hospitalization risk. Traditional management strategies focus on erythropoiesis-stimulating agents (ESAs) and iron supplementation, but novel therapies like HIF-PHIs are emerging as promising interventions. The review also discusses the role of various factors such as EPO dysregulation, iron dysregulation, inflammation, bone marrow dysfunction, vitamin B12 and folic acid deficiencies, and other factors in the development of anemia in CKD. The diagnosis of anemia in CKD involves assessing hemoglobin levels, transferrin saturation (TSAT), serum ferritin, and other biomarkers. Iron status assessment is crucial for determining the cause and appropriate treatment of anemia in CKD patients. The management of anemia in CKD includes ESA, iron supplementation, and addressing reversible causes. However, the efficiency of these treatments can be affected by chronic inflammation and increased hepcidin levels, which may lead to secondary anemia from ESA administration. The review also highlights the importance of novel biomarkers in the evaluation and management of anemia in CKD.Anemia is a common complication in chronic kidney disease (CKD) and significantly impacts patients' quality of life and clinical outcomes. The pathophysiology of anemia in CKD involves multiple factors, including erythropoietin (EPO) deficiency, iron dysregulation, chronic inflammation, bone marrow dysfunction, and nutritional deficiencies. Despite advances in understanding this condition, anemia remains a significant clinical challenge in CKD patients. Guidelines aim to standardize the diagnosis and treatment of anemia, but recommendations vary between publications. Recent studies suggest that novel biomarkers may help evaluate anemia and related conditions like iron deficiency in CKD patients. This review summarizes the pathophysiology, diagnosis, and management of anemia in CKD, including novel therapeutic approaches such as hypoxia-inducible factor-prolyl hydroxylase inhibitors (HIF-PHIs). Understanding these complex mechanisms is crucial for effective diagnosis and treatment of anemia in CKD patients. Anemia in CKD is not only a marker of disease severity but also a predictor of adverse outcomes, including cardiovascular events and mortality. It is also associated with worse quality of life and increased hospitalization risk. Traditional management strategies focus on erythropoiesis-stimulating agents (ESAs) and iron supplementation, but novel therapies like HIF-PHIs are emerging as promising interventions. The review also discusses the role of various factors such as EPO dysregulation, iron dysregulation, inflammation, bone marrow dysfunction, vitamin B12 and folic acid deficiencies, and other factors in the development of anemia in CKD. The diagnosis of anemia in CKD involves assessing hemoglobin levels, transferrin saturation (TSAT), serum ferritin, and other biomarkers. Iron status assessment is crucial for determining the cause and appropriate treatment of anemia in CKD patients. The management of anemia in CKD includes ESA, iron supplementation, and addressing reversible causes. However, the efficiency of these treatments can be affected by chronic inflammation and increased hepcidin levels, which may lead to secondary anemia from ESA administration. The review also highlights the importance of novel biomarkers in the evaluation and management of anemia in CKD.