Article

Anemia, Renal Dysfunction, and Their Interaction in Patients With Chronic Heart Failure

Academic Cardiology, University of Hull, Castle Hill Hospital, Cottingham, United Kingdom.
The American Journal of Cardiology (Impact Factor: 3.43). 08/2006; 98(3):391-8. DOI: 10.1016/j.amjcard.2006.01.107
Source: PubMed

ABSTRACT Anemia and renal dysfunction (RD) are frequent complications seen in chronic heart failure (HF). However, the prevalence and interaction of these co-morbidities in a representative population of outpatients with chronic HF is poorly described. In this study, it was sought to determine the association between RD and anemia in patients with HF enrolled in a community-based HF program. Nine hundred fifty-five patients with HF due to left ventricular systolic dysfunction were investigated for the prevalence of anemia and its cause and followed for a median of 531 days. Anemia was defined as hemoglobin < 12.0 g/dl in women and < 13.0 g/dl in men. RD was defined as a calculated glomerular filtration rate of < 60 ml/min. The prevalence of anemia was 32%. Fifty-three percent of patients with and 27% of those without anemia had > or = 1 test suggesting hematinic deficiency. The prevalence of RD was 54%. Forty-one percent of patients with and 22% of patients without RD had anemia, with similar proportions associated with iron deficiency in the presence or absence of RD. Anemia and RD independently predicted a worse outcome, and this effect was additive. In conclusion, in outpatients with chronic HF, anemia and RD are common and co-exist but confer independent prognostic information. A deficiency of conventional hematinic factors may cause about 1/3 of anemia in this clinical setting.

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    ABSTRACT: Anaemia is one of the most frequent co-morbidities in patients with heart failure. Its prevalence increases from 4% to7% in subjects with asymptomatic left ventricular dysfunction to >30% in patients with severe heart failure. Renal insufficiency, activation of inflammatory mediators and treatment with renin-angiotensin antagonists seem to be its main determinants. The results of many studies agree in providing evidence that anaemia is a powerful independent determinant of survival in patients with heart failure. However, the mechanisms of this relation are still not fully understood. Moreover a favourable effect of the correction of anaemia on prognosis has not yet been shown. Also In addition to this, controlled studies assessing its effects on exercise tolerance have yielded controversial results. Further research is needed to assess the effect of correcting anaemia in chronic heart failure (CHF) patients; ongoing reduction of events with RED-HF (Darbepoetin alpha in heart failure) trial will help define the role. KeywordsAnaemia-Heart failure-Erythropoietin
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    ABSTRACT: Artículo original RESUMEN Hasta la fecha muy pocos estudios han evaluado el efecto de la suplementación con hierro parenteral, no asociado al uso de Agentes Estimulantes de la Eritropoyesis (AEE) en el síndrome de Anemia cardio-Renal (cRAs). Objetivos. Primarios: evaluar el efecto del hierro sacarato IV sin AEE sobre: 1) los niveles de Hb; 2) la fracción de eyección del ventrículo izquierdo (FEVI); 3) la clase funcional de la Asociación del corazón de Nueva York (NYHA); 4) la función renal; y 5) la calidad de vida de los pacientes con cRAs. secundarios: determinar el cambio en el nivel del NT-proBNP y el estado inflamatorio, medido por la Proteína c Reactiva (PcR). Métodos. se diseñó un estudio prospectivo, multicéntrico, con-trolado, doble ciego y aleatorizado. La población del estudio fueron pacientes adultos de ambos sexos con cRAs. se conformaron dos grupos: al Grupo A se le continuó administrando la terapia conven-cional para el manejo de la Icc y placebo; el grupo B, además incluyó la administración de hierro sacarato endovenoso (Venofer®) 200 mg/ sem 5 semanas. El estudio comprendió una fase de corrección (5 primeras semanas) y una fase de seguimiento (5 visitas control cada mes hasta completar 6 meses) en las que se administraba una dosis de mantenimiento de hierro sacarato IV 200 mg o placebo. Resultados. se incluyeron 20 pacientes de los cuales 16 comple-taron el estudio. Hubo mejoría en los pacientes que recibieron hierro sacarato IV asociado a la terapia convencional y plena de la Icc, frente al placebo. se evidenció disminución en los síntomas y signos de Icc, corroborados por una mejoría en la calidad de vida. De igual forma, los marcadores hemodinámicos mostraron una mejoría con significancia estadística en el grupo de terapia con hierro sacarato IV. En igual sentido se encontraron los parámetros paraclínicos evaluados. El grupo que recibió terapia con hierro sacarato IV, mejoró la función renal en comparación con el grupo control con disminución de los marcadores inflamatorios. Conclusión. Aunque la muestra de nuestro estudio fue pequeña, genera bastante interés el potencial terapéutico del hierro sacarato IV en esta población de pacientes. Por lo tanto, se hacen necesarios estudios con una muestra de mayor tamaño, mayor tiempo de segui-miento y que valoren los desenlaces de la intervención. AbStRAct To date very few studies have evaluated the effect of the suplemen-tación with parenteral iron, not associated to the use of Erythropoiesis stimulating Agents (EsA) in the cardio-Renal Anemia syndrome (cRAs). Objectives. Primary: to assess the effect of iron sucrose IV without EsA on: 1) Hb levels; 2) left ventricular ejection fraction (LVEF); 3) New York Heart (NYHA) functional classification; 4) the renal function; and 5) the quality of life of patients with cRAs. secondary: to assess the change in the NT-proBNP level and the inflammatory state, measured by c-Reactive Protein (cRP). Methods. A prospective, multi-centre, controlled, double-blind and randomized study was designed. The population of the study was adults patients both sex with cRAs. Two groups were studied: Group A received the administration of the conventional therapy for cHF and placebo; Group B, in addition included iron sucrose IV administration (Venofer®) 200 mg/wk 5 weeks. The study included a correction phase (first 5 weeks) and a follow-up phase (5 visits every month until completing 6 months) administering a dose of iron sucrose for maintenance IV 200 mg or placebo. Results. 20 patients were recruited of whom 16 completed the study. There was improvement in the patients who received iron su-crose IV to the conventional and total therapy of the cHF, compared to placebo. It was evidenced diminution in the cHF symptoms and signs, corroborated by an improvement in the quality of life. similarly, the hemodynamics markers showed an improvement with statistical significance in the group of therapy with iron sucrose IV. In the same way were found the laboratory parameters. The group that received therapy with iron sucrose IV, improved renal function in comparison with the control group with diminution of the inflammatory markers. Conclusion. Although the sample of our study was small, generates enough interest the therapeutic potential of iron su-crose IV in this population of patients. Therefore, other studies with a larger sample, longer follow-up time and assessment of intervention outcomes are necessary.
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