OBJECTIVES: To evaluate trends in epoetin alfa (EPO) and darbepoetin alfa (DARB) dosing patterns and drug costs from 2005–2006 in elderly patients with pre-dialysis chronic kidney disease (CKD) receiving care in nephrology clinics. METHODS: A random panel of approximately 250 nephrologists was requested to review the medical records of their two most recently seen anemic pre-dialysis CKD patients who were receiving an erythropoiesis-stimulating therapy (EST). Patients were included in this analysis if they were >=65 years old and received therapy between October 2005 and October 2006. Patient demographics, comorbid conditions, baseline hemoglobin, CKD status, EST dose, and frequency of administration were collected. Drug cost was based on average weekly dose and September 2006 wholesale acquisition cost (EPO $12.17/1000 Units; DARB $4.446/mcg). RESULTS: 862 patient charts were reviewed; 556 patients met eligibility criteria (EPO: 351; DARB: 205). Patient demographics, comorbid conditions, baseline hemoglobin, and CKD status were similar between groups. Weekly and extended (>= every two weeks [>=Q2W]) dosing patterns were seen in both groups (EPO: QW, 39%; >=Q2W, 61%; DARB: QW, 8%; >=Q2W, 92%). The average weekly dose over the course of the study (EPO: 10,719 units; DARB: 48 mcg) corresponded to a dose ratio of 223:1 (Units EPO: mcg DARB) and weekly costs of $130 for EPO and $213 for DARB. CONCLUSION: The doses and 39% lower drug cost in the EPO group observed in this study were similar to those published from earlier time periods. The results reported here should be of assistance to clinicians and formulary decision makers in identifying current real-world dosing and subsequent cost of treatment of these two erythropoietic agents.