Our understanding of the HIF PHDs and its regulation first time enables us to develop pharmacological inhibitors to stabilize HIF1 and HIF2 even in the presence of oxygen. Stabilisation of both isoforms may be beneficial in particular for ischemic diseases in order to prepare tissues for a period of insufficient oxygen supply and lack of energy substrates. In the last years especially for the kidney, which has a highly developed and specialized HIF and PHD system, pharmacological HIF stabilisation has been shown to be protective in experimental ischemic and toxic renal injuries. Pharmacological HIF stabilisation was particular useful, when HIF was preconditionally stabilized prior to the injury, but was less effective after the injury. Therefore, in conditions like transplantation, administration of toxic substances or surgery procedures HIF stabilisation could be effective. On the other hand many efforts have been meanwhile undertaken to evaluate HIF2 stabilisation to treat renal anemia and to substitute or to support erythropoietin therapy. This would require a long term therapy and would involve long term activation of HIF pathways. In this talk, therapeutic options and limitations of HIF stabilisation in particular for acute and chronic kidney diseases are discussed and new aspects of pharmacological PHD inhibition from our and other labs are reported.