Iron management in nondialysis-dependent CKD.

Iron deficiency has been studied extensively in patients with chronic kidney disease on hemodialysis therapy. However, few studies looked at iron treatment in the nondialysis chronic kidney disease population. Limited data suggest that iron deficiency is common in patients with chronic kidney disease with anemia; this lack of iron can hinder the effectiveness of erythropoiesis. The diagnosis of iron deficiency should involve clinical judgment, with an emphasis on clinical characteristics of the patient because of the limited amount of literature examining the interpretation of iron testing results. When iron deficiency is diagnosed in nondialysis patients with chronic kidney disease, a search must be initiated for any sources of blood loss. After addressing any blood loss, the preferred route of iron treatment must be determined. To date, no clear advantage was shown with intravenous versus oral administration in nondialysis patients, as shown in the hemodialysis setting. Thus, oral iron therapy may be a more reasonable option unless oral therapy previously failed. Additional research is needed to support evidence-based guidelines for the treatment of iron deficiency in the nondialysis chronic kidney disease population because this population differs from hemodialysis patients in the decreased extent of blood loss.