© 2002 European Society of Cardiology
The importance of anemia and its correction in the management of severe congestive heart failure
a Department of Nephrology, Tel Aviv Medical Center Weizman 6, Tel Aviv 64239, Israel
b Department of Cardiology and Congestive Heart Failure Out Patient Unit, Tel Aviv Medical Center Weizman 6, Tel Aviv 64239, Israel
* Corresponding author. Tel.: +972-3-6973270; fax: +972-3-5469825. E-mail address: donald{at}netvision.net.il
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Abstract |
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About half of all the patients with CHF are anemic (they have a hemoglobin of <12 g%). The prevalence and severity of this anemia increase with increasing severity of the CHF. The anemia is caused by a combination of poor nutrition, associated renal insufficiency causing inappropriately low Erythropoietin (EPO) levels, bone marrow depression and EPO resistance caused by excessive TNF alpha and other factors, gastrointestinal blood loss caused by aspirin, ACE inhibitors, EPO loss in the urine with proteinuria, and hemodilution caused by the excessive plasma volume. Studies have shown that the anemia is an independent risk factor for death in CHF, almost doubling the mortality rate. Correction of the anemia with subcutaneous EPO and IV iron improves cardiac function and functional capacity, helps prevent the progression of renal failure, markedly reduces hospitalization and diuretic doses, and improves self assessed quality of life. This so-called Cardio Renal Anemia Syndrome is very common in CHF. Its successful treatment demands close cooperation between cardiologists and nephrologists.
Key Words: Anemia • Renal failure • Congestive heart failure • Erythropoietin • Iron
Received August 17, 2001; Revised December 10, 2001; Accepted February 22, 2002
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