Iron deficiency, both functional and absolute, is common in patients with chronic kidney disease and in those requiring dialysis. The Renal National Service Framework and National Institute for Health and Clinical Excellence advocate treatment of anemia in patients with chronic kidney disease. Oral iron is often both insufficient and slow to improve hemoglobin levels while intravenous supplementation replenishes and maintains iron stores more effectively. This leads to a reduction in the use of erythropoietin stimulating agents. This reduction in erythropoietin stimulating agents use may be potentially beneficial in certain cases in particularly reducing stroke risk. In contrast, intravenous iron has the potential to improve quality of life, reduce cardiovascular risk and produce cost savings. However, long-term clinical data are needed to reassure one of the effectiveness of parenteral iron therapy and exclude potential long-term cellular and systemic adverse effects.