This paper attempts to present a context in which nephrologists can re-evaluate definitions of acceptable haemoglobin levels in renal populations, and re-examine previous notions about the impact of relative and absolute anaemia on patients with progressive renal insufficiency. Also, the nephrology community needs to examine rigorously treatment strategies aimed at reversing anaemia specifically in this population. Data are presented to support the notion that anaemia is disadvantageous to the patients with progressive renal insufficiency, and does need to be treated. The ongoing poor prognosis of patients receiving renal replacement therapy may well be due to our previous inattention to this correctable cause of morbidity early in the course of progressive renal disease. Long-term studies addressing these important clinical issues need to be supported, and evaluated within both immediate and future economic implications.