BACKGROUND: Governments across Europe are increasingly focused on controlling rising health care costs. Within this context, a major challenge for haemodialysis centres is to maximise efficiencies while maintaining high standards of care. OBJECTIVES:  The aim of this study was to document health care personnel time for anaemia management in maintenance therapy for both shorter-acting erythropoiesis-stimulating agents (ESA) and a continuous erythropoiesis receptor activator (C.E.R.A.) once monthly (Q4W), and model time savings following the introduction of Q4W C.E.R.A. in five European countries. METHODS:  A multinational, multicentre time and motion study has been conducted in 16 centres across Germany, France, Italy, Poland and Spain. The time spent on frequent anaemia management-related tasks (preparation, distribution, injection, record-keeping) was recorded in each centre by trained observers. Time/pt/session was used to calculate time/pt/year, time/centre/year and for modelling potential time savings with a 100% uptake of C.E.R.A. RESULTS:  Numbers of ESA injections/pt/year, weighted by type of ESA, frequency and route of administration, ranged from 53-148. The mean uptake of C.E.R.A. Q4W across 16 centres was 29% (7-56%). The mean annual reduction in the number of ESA administrations following conversion to C.E.R.A. was 76 (41-136). Estimated observed time/pt/year ranged from 38-310 min for ESA and 6-68 min for C.E.R.A. Assuming a 100% uptake of Q4W C.E.R.A. maintenance therapy, annual time savings/centre for frequent anaemia management tasks would be 84% (79-91%) in Germany, 78% (74-86%) in France, 88% (87-88%) in Italy, 85% (78-88%) in Poland and 77% (69-84%) in Spain. CONCLUSIONS:  Substantial annual time savings on frequent anaemia management-related tasks were consistently found in haemodialysis centres across five European countries with a 100% uptake of Q4W C.E.R.A. maintenance therapy. This provides the opportunity to re-focus health care resources, at a critical time point in the dialysis procedure, on other important CKD care tasks in order to improve overall pt care.