Intravenous iron therapy in chronic kidney disease–associated anemia: Current evidence on efficacy and safety

Background: CKD–associated anemia is one of the most common and clinically significant complications of CKD, contributing to increased cardiovascular morbidity, and reduced quality of life. In addition to impaired erythropoietin production, iron dysregulation mediated by chronic inflammation and elevated hepcidin levels plays a central role in anemia pathogenesis. IV iron therapy has emerged as an increasingly important therapeutic strategy, particularly in patients with functional iron deficiency and inadequate response to oral iron supplementation.
Methods: A narrative review was conducted using literature from PubMed, Google Scholar, Scopus, and ScienceDirect published between 2015 and 2025. Studies discussing the efficacy and safety of IV iron therapy in CKD-associated anemia were included.
Results: Current evidence demonstrates that IV iron therapy provides superior hematologic efficacy compared with oral iron supplementation by improving hemoglobin levels, replenishing iron stores, and reducing erythropoiesis-stimulating agent (ESA) requirements. Landmark trials such as FIND-CKD and PIVOTAL further support the role of proactive IV iron administration in improving anemia-related outcomes without significantly increasing infection risk or serious adverse events. Modern IV iron formulations generally exhibit favorable safety profiles, although concerns regarding oxidative stress, iron overload, hypersensitivity reactions, and hypophosphatemia remain important clinical considerations.
Conclusion: Intravenous iron therapy has become a cornerstone in the management of CKD-associated anemia, particularly among patients with functional iron deficiency, ESA hyporesponsiveness, and dialysis dependence. Contemporary evidence supports its efficacy and acceptable safety profile when administered with appropriate monitoring and individualized treatment strategies.