Comparing Efficacy and Safety of CinnaGen Beta Erythropoietin (CinnaPoietin®) Versus Eprex® on the Treatment of Anemia in ESRD Hemodialysis Patients

Inclusion Criteria: * Aged between 18 and 70 * ESRD patients who are on hemodialysis for ≥3 months. * Hb level 8- 11.5 g/dl * Patients are on adequate hemodialysis: the minimally adequate dose of hemodialysis given 3 times per week should be a spKt/V (single-pool delivered Kt/V; clearance of urea x dialysis time/volume of distribution) of 1.2 per dialysis. For treatment periods of less than 5 hours, an alternative minimum dose is a urea reduction rate (URR) of 65%. All types of hemodialysis systems and hemodiafiltration, including high-flux membranes are allowed as long as there is no plan to change the patient's regimen during the study. * Sufficient iron stores, defined as serum ferritin ≥ 200 ng/ml and transferrin saturation ≥20%. (Patients not meeting these criteria may receive iron supplementation therapy during the Screening and stabilization period to appropriately correct their iron store deficiency to meet the criterion required for randomization); * Ability to comply with study medication use, study visits, and study procedures as judged by the investigator; * Females of childbearing potential agree to use an acceptable method of birth control (e.g., abstinence, hormonal or barrier methods, partner sterilization, or IUD) for the duration of the study. * Qualified and willing to sign the informed consent form with the commitment of complying with all the scheduled visits, and study procedures as judged by the investigator; * In any circumstances that potential participants are not able to give consent, it may be given by responsible parents or guardian. Exclusion Criteria: * Uncontrolled hypertension (defined as pre-dialysis diastolic blood pressure ≥ 100 mmHg or systolic blood pressure ≥180 mmHg); * Anemia secondary to other causes different to the CKD (e.g. multiple myeloma, aplastic anemia, leukemia;….) * Decompensated liver failure; * Clinical evidence of concurrent uncontrolled hyperparathyroidism (defined as serum parathyroid hormone (iPTH) \> 800 pg/ml); * Heart failure \[New York Heart Association (NYHA) class III and IV\]; * Unstable angina pectoris, active cardiac disease, stroke and/or cardiac infarction within the last 6 months; * History of or active blood coagulation disorders including DVT, PTE, native access Thrombosis during last 6 months. * Thrombocytosis (platelet count \> 500,000/µl); * Thrombocytopenia (platelet count \< 100,000/µl); * White blood cell count \< 3,000/µl); * White blood cell count \>15,000/µl) * Recent Bleeding (acute or chronic bleeding within three months prior to screening); * Suspicion of or confirmed occult bleeding (increased reticulocyte count); * Clinical evidence of concurrent systemic infection, or inflammatory disease (e.g; diabetic foot, bed sore, access infection, CRP\> 30 mg/l,…) * Currently receiving treatment for epilepsy; * Major surgery within 3 months prior to randomization and during the conduct of the trial (except vascular access surgery); * Concomitant immunosuppressive therapy; patients on a short course of steroids (up to 7 days), topical or intranasal steroids are allowed in the study; * History of any malignant disease within the last 5 years (except excised non-melanoma skin cancer); * Women who are pregnant or breastfeeding; * Known history of severe drug-related allergies; * Known history of drug related allergy to Erythropoietin or one of the ingredients of the test or the reference products or hypersensitivity to mammalian-derived products; * Transplant received within one year prior to the start of the study; * Simultaneous participation in another clinical study or having received an Investigational Medicinal Product within three months before randomization in this study. * Psychiatric, addictive (drugs or alcohol) or any other disorder that compromises the ability to give an informed consent; * Any red blood cell transfusion during the last 3 months (measured at the time of eligibility verification); * Primary hematological disorder (e.g. myelodysplastic syndrome, myeloma, sickle cell anemia, hematological malignancy, multiple myeloma hemolytic anemia); * known resistance to the rHuEPO defined by a requirement \> 450 IU/kg/week by IV or 300 IU/kg/week by SC, equivalent to approximately 20.000 IU/week SC and in absence of iron deficiency; * who have suffered an event of active bleeding in the 30 days prior to the beginning of the study; * Morbid obesity, defined by a Body Mass Index (BMI) \> 37 kg/m2 in women and \> 40 kg/m2 in men.