Would you recommend oral or intravenous iron in a chronic kidney disease stage 4 patient who is not on an ESA and has a hemoglobin of 12.7 g/dl and an iron saturation of less than 20%?

I would not necessarily treat this patient with iron at all. I would check serum ferritin. If low would do a colonoscopy or look for causes of iron deficiency. If not low would observe. In general though for patients with CKD (not on dialysis yet) who need iron therapy, I would try oral iron first. ...

Since Hb is at goal for 10-12, this patient technically doesn't meet the criteria for treatment of anemia in someone with advanced CKD. Checking the entire iron panel including Ferritin and TIBC would give a better indicator of underlying causes of low TSat. If Ferritin <30 (absolute iron deficiency...

No way would I use IV iron for that situation. Cost hassle safety. I would start oral iron one pill three times a week and recheck in 6 months. Probably should consider the source of loss, not sure I would just yet.