OBJECTIVES:  Effective management of chronic kidney disease (CKD)-associated anaemia has been established for all erythropoiesis-stimulating agents (ESAs).  The aim of this study was to establish the real-life doses and comparative costs of both short-acting ESAs and the newer longer-acting ESAs, darbepoetin alfa and the continuous erythropoietin receptor activator (C.E.R.A), and to forecast the impact of a change in current prescribing practice on health care budgets in Europe.  METHODS:   A retrospective chart review of CKD-associated anaemia management in 1014 pre-dialysis and 1016 dialysis patients was carried out by 261 nephrologists across the UK, Italy, Germany, Spain and France, between August 2008 and September 2009.  Data collected on ESA dosing were used to populate a UK budget impact model comparing current prescribing practice with specific focus on C.E.R.A and darbepoetin alfa, over a five-year time horizon.  Data on the number of patients, ESA market shares, and unit drug costs were derived from UK sources.  RESULTS:   The average monthly doses of ESAs in the combined five European markets (5EU) were as follows: epoetin alfa (pre-dialysis, 19,350 International Units (IU); dialysis, 35,404 IU); epoetin beta (pre-dialysis, 18,230 IU; dialysis, 36,789 IU); darbepoetin alfa (pre-dialysis, 107 μg; dialysis, 169 μg); C.E.R.A (pre-dialysis, 98 μg; dialysis, 150 μg).  The model based on UK doses showed, that after five years, an increase in the use of C.E.R.A to 40% would reduce the overall ESA budget for CKD-associated anaemia by 15% compared to current prescribing practice.  CONCLUSIONS:   Based on real-life data, an increase in C.E.R.A prescribing may result in a cost-saving for the management of CKD-associated anaemia in the UK.  This model can be applied to other European markets to forecast the local impact of a change in current prescribing practice.