When the patient is believed to have CKD-related anemia, appropriate diagnostics should be completed so findings can guide the next course of action. For example, if a patient displays signs consistent with iron deficiency based on serum ferritin results and transferrin saturation, occult gastrointestinal malignancy should be excluded before initiation of iron therapy. When iron stores are replenished and Hgb is less than or equal to 10 g/dL, erythropoietin-stimulating agent (ESA) therapy may be initiated with frequent monitoring of iron stores. Patients who have signs consistent with vitamin B]2 or folate deficiency also should be supplemented with B12 and folate before initiation of ESA therapy. If no signs of iron, B]2, or folate deficiency exist and the patient has Hgb less than or equal to 10 g/dL, ESA may be initiated immediately with frequent iron stores testing (Taliercio, 2010). In summary, treatment for anemia should not be initiated before testing for underlying causes. When any identified causes are treated or eliminated and the patient continues to maintain Hgb less than or equal to 10 g/dL, ESAs