Blood Purification

Review

The Interaction between Heart Failure, Renal Failure and Anemia – The Cardio-Renal Anemia Syndrome

Silverberg D.S. · Wexler D. · Blum M. · Wollman Y. · Schwartz D. · Sheps D. · Keren G. · Iaina A.

Author affiliations

Department of Nephrology and Cardiology, Tel Aviv Medical Center, Tel Aviv, Israel

Keywords: Heart failureKidney insufficiencyErythropoietinIronAnemia

Related Articles for ""
Blood Purif 2004;22:277–284
https://doi.org/10.1159/000078698

Log in to MyKarger to check if you already have access to this content.




Forgot your password
Sign up to MyKarger

Buy

  • FullText & PDF
  • Unlimited re-access via MyKarger
  • Unrestricted printing, no saving restrictions for personal use
read more
CHF 38.00 *
EUR 35.00 *
USD 39.00 *

Select

KAB

Buy a Karger Article Bundle (KAB) and profit from a discount!


If you would like to redeem your KAB credit, please log in.

Save over 20% compared to the individual article price.

Learn more

Rent/Cloud

  • Rent for 48h to view
  • Buy Cloud Access for unlimited viewing via different devices
  • Synchronizing in the ReadCube Cloud
  • Printing and saving restrictions apply
Rental: USD 8.50
Cloud: USD 20.00

Select

Subscribe

  • Access to all articles of the subscribed year(s) guaranteed for 5 years
  • Unlimited re-access via Subscriber Login or MyKarger
  • Unrestricted printing, no saving restrictions for personal use
read more

Subcription rates

Select
* The final prices may differ from the prices shown due to specifics of VAT rules.

Article / Publication Details

First-Page Preview
Abstract of Review

Received: January 23, 2004
Accepted: March 12, 2004
Published online: July 09, 2004
Issue release date: May 2004

Number of Print Pages: 8
Number of Figures: 0
Number of Tables: 0

ISSN: 0253-5068 (Print)
eISSN: 1421-9735 (Online)

For additional information: https://www.karger.com/BPU

Abstract

Background: Many patients with congestive heart failure (CHF) have chronic kidney insufficiency (CKI) and anemia. Aims: The purpose of this review is to clarify the relationship between these three factors and to study the effect of correction of anemia in CHF and CKI. Findings: Anemia, CHF and CKI are each capable of causing or worsening each other. Thus they form a vicious circle which can result in progressive CHF, CKI and anemia. Aggressive therapy of CHF, CKI and control of the associated anemia with erythropoietin and i.v. iron can prevent the progression of CHF and CKI, reduce hospitalization, and improve quality of life. Conclusion: CHF patients are a major source of end-stage renal failure patients and deserve special attention. If treated well and early, progressive heart failure and renal failure can be prevented. Cooperation between nephrologists, cardiologists, and other internists will improve the care of all three conditions and prevent their progression.

© 2004 S. Karger AG, Basel



Related Articles:

References

  1. Miller LW, Missov ED: Epidemiology of heart failure. Cardiol Clin 2001;19:547–555.
    External Resources
  2. Cowie MR, Mosterd A, Wood DA, et al: The epidemiology of heart failure. Eur Heart J 1997;18:208–225.
    External Resources
  3. McMurray JJV, Stewart S: The burden of heart failure. Eur Heart J Suppl 2002:4(suppl D): D50–58.
  4. Levy D, Kenchaiah S, Larson MG, et al: Long term trends in the incidence of and survival with heart failure. N Engl J Med 2002;347:1397–1402.
    External Resources
  5. Cleland FGF, Cohen-Solal A, Aguillar JC, et al: Management of heart failure in primary care (The IMPROVEMENT of heart failure programme): An international survey. Lancet 2002;360:1631–1639.
    External Resources
  6. Silverberg DS, Wexler D, Blum M, et al: The use of subcutaneous erythropoietin and intravenous iron for the treatment of the anemia of severe, resistant congestive heart failure improves cardiac and renal function, functional cardiac class, and markedly reduces hospitalizations. J Am Coll Cardiol 2000;35:1737–1744.
    External Resources
  7. Anand IS, Chandrashekhar Y, Ferrari R, Poole-Wilson PA, Harris PC: Pathogenesis of edema in chronic anemia: Studies of body water and sodium, renal function, haemodynamics and plasma hormones. Brit Heart J 1993;70:357–362.
    External Resources
  8. Packer M, Cohn JN, et al: Consensus recommendations for the management of chronic heart failure. Am J Cardiol 1999;83:1A–38A.
    External Resources
  9. Hunt SA, Baker DW, Chin MC, et al: ACC/AHA guidelines for the evaluation and management of chronic heart failure: Executive summary. J Am Coll Cardiol 2001;38:2101–2113.
    External Resources
  10. Jessup M, Brozena S: Heart failure. N Engl J Med 2003;348:2007–2118.
    External Resources
  11. Alexander M, Grumbach K, Remy L, Rowell R, Massie BM: Congestive heart failure hospitalizations and survival in California: Patterns according to race/ethnicity. Am Heart J 1999;137:919–927.
    External Resources
  12. Chatterjee B, Nydegger UE, Mohacsi P: Serum erythropoietin in heart failure treated with ACE inhibitors of AT1 antagonists. Eur J Heart Fail 2000;2:392–398.
  13. Polanczyk CA, Newton C, Dec GC, Di Salvo TG: Quality of care and hospital readmission in congestive heart failure: An explicit review process. J Card Fail 2001;7:289–298.
    External Resources
  14. Felker GM, Gattis WA, Leimberger JD, et al: Usefulness of anemia as a predictor of death and rehospitalization in patients with decompensated heart failure Am J Cardiol 2003;92:625–628.
  15. Wisniacki N, Aimson P, Lyle M: Is anemia a cause of heart failure in the elderly? (abstract). Heart 2001;85(suppl I):P4.
  16. Al-Ahmad A, Rand WM, Manjunath G, et al: Reduced kidney function and anemia as risk factors for mortality in patients with left ventricular dysfunction. J Am Coll Cardiol 2001;38:955–962.
    External Resources
  17. McClellan WM, Flanders WD, Langston RD, et al: Anemia and renal insufficiency are independent risk factors for death among patients with congestive heart failure admitted to community hospitals: A population-based study. J Am Soc Nephrol 2002;13:1928–1936.
    External Resources
  18. Tanner H, Moschovitis G, Kuster P, et al: The prevalence of anemia in chronic heart failure. Int J Cardiol 2002;86:115–121.
    External Resources
  19. Horwich TB, Fonarow GC, Hamilton MA, et al: Anemia is associated with worse symptoms, greater impairment in functional capacity and a significant increase in mortality in patients with advanced heart failure. J Am Coll Cardiol 2002;39:1780–1786.
    External Resources
  20. Trovato GM, Catalano D, Vitale M, et al: Malnutrition and anemia in heart failure (CHF) without renal insufficiency (abstract). Nephrol Dial Transplant 2002;17(suppl):T138.
  21. Cromie N, Lee C, Struthers AD: Anaemia in chronic heart failure: What is the frequency in the UK and its underlying cause? Heart 2002;87:377–378.
  22. Maggioni AP, Latini R, Anand I, et al: Prevalence and prognostic role of anemia in patients with heart failure in the IN-CHF Registry and the Val-HeFT trial. Eur Heart J 2002;4(suppl):abstract 1480.
  23. Szachniewicz J, Petruk-Kowalczyk J, Majda J, et al: Anemia is an independent predictor of poor outcome in patients with chronic heart failure. Int J Cardiol 2003;90:303–308.
    External Resources
  24. Anker SD, Sharma R, Fracis D, Pitt B, Poole-Wilson PA, Coats AJS: Anemia and survival in 3044 patients with Chronic Heart Failure (CHF) in the ELITE II Study (abstract). Circulation 2002;106(suppl):2335A.
  25. Ezekowitz J, Franjic N, Chang W-C, Armstrong PW: What is the relationship between anemia and survival in patients with CHF? A population-based analysis of 29,302 patients (abstract). Circulation 2002;106(suppl):2334A.
  26. Jozwiak A, Guzik P, Chmielewski Z: Total in hospital mortality in older patients with heart failure. Eur J Heart Fail Suppl 2002;1:71A.
  27. Golden JS, Fallick CC, Josephson SR, et al: Baseline hematocrit predicts clinical outcomes in heart failure (abstract). Circulation 2002;106(suppl):3358A.
  28. Bolger AP, Doehner W, Sharma R, Coate JS, Anker S: Anemia in chronic heart failure: The relationship to inflammatory cytokine production and prognostic importance (abstract). Circulation 2002;106(suppl):2819A.
  29. Herzog CA, Li S, Collins AJ: The impact of congestive heart failure (CHF), chronic kidney disease (CKD) and anemia on survival in the medicare population (abstract). Circulation 2002;106(suppl):2333A.
  30. Gilbertson D, Li S, Murray AM, Herzog CA, Collins AJ: Competing risks of death vs. ESRD in Medicare beneficiaries age 65+ with chronic kidney disease, CHF and anemia (abstract). J Am Soc Nephrol 2002;13:SA848.
  31. Berry C, Brett M, Stevenson K, Norrie J, McMurray J: Predictors in in-patient mortality following emergency heart failure hospitalization. J Am Coll Cardiol 2003;41(suppl A): 1039–1061A.
  32. Tang WHW, Miller H, Partin M, et al: Anemia in ambulatory patients with chronic heart failure: A single-center clinical experience derived from electronic medical records. J Am Coll Cardiol 2003;41(suppl A):157A.
  33. Ezekowitz J, McAlister FA, Armstrong PW: Anemia is common in heart failure and is associated with poor outcomes. Circulation 2003;107:223–225.
    External Resources
  34. Androne AS, Katz SD, Lund L, et al: Hemodilution is common in patients with advanced heart failure. Circulation 2003;107:226–229.
    External Resources
  35. Kalra PR, Bolger AP, Francis DP, et al: Effect of anemia on exercise tolerance in chronic heart failure. Am J Cardiol 2003;91:888–891.
    External Resources
  36. Macin SM, Perna ER, Farias EF, et al: Anemia is a highly prevalent condition in decompensated heart failure with prognostic implication. Eur J Heart Fail Suppl 2003;2:295A.
  37. Mozaffarian D, Nye R, Levy WC: Anemia predicts mortality in severe heart failure. J Am Coll Cardiol 2003;41:1933–1939.
    External Resources
  38. Poole-Wilson PA, Uretsky BF, Thygesen K, et al: Mode of death in heart failure: Findings from the ATLAS study. Heart 2000;89:42–48.
  39. Kosiborod M, Smith GL, Radford MJ, et al: The prognostic importance of anemia in patients with heart failure. Am J Med 2003;114:112–119.
    External Resources
  40. Ryan E, Ledwidge MT, McDonald KM: Anaemia in a heart failure management program: Iron deficiency or anaemia of chronic disease. Eur J Heart Fail Suppl 2003;2:225A.
  41. Johnson DB, Dell’Italia LJ: Cardiac hypertrophy and failure in hypertension. Curr Opin Nephrol Hypertens 1996;5:186–191.
    External Resources
  42. Katz AM: The cardiomyopathy of overload: An unnatural growth response in the hypertrophied heart. Ann Intern Med 1994;121:363–371.
    External Resources
  43. Grune T, Sommerburg O, Siems WG: Oxidative stress in anemia. Clin Nephrol 2000;53(suppl 1):S18–S22.
  44. Siems WG, Sommerburg O, Grune T: Erythrocyte free radical and energy formation. Clin Nephrol 2000;53(suppl 1):S9–S17.
  45. Levin A, Djudjev O, Duncan J, Werb R, Taylor P: Hemoglobin levels prior to therapy predict survival in chronic kidney disease (CKD) patients. Nephrol Dial Transplant 2003;18(suppl 4):T358A.
  46. Collins AJ: Influence of target hemoglobin in dialysis patients on morbidity and mortality. Kidney Int 2002;61(suppl 80):S44–S48.
  47. Ofstun N, LaBrecque J, Lacson E, Keen M, Lazarus JM: The effects of higher hemoglobin levels on mortality and hospitalization in hemodialysis patients. Kidney Int 2003;63:1908–1914.
    External Resources
  48. St Peter WL, Xue J, Ebben J, Collins A: Pre-end stage renal disease erythropoietin use predicts hospitalization in the periods before and after end-stage renal disease diagnosis. J Am Soc Nephrol 2001;12(suppl):abstract 1274.
  49. Collins AJ: Anaemia management prior to dialysis: Cardiovascular benefits and cost-benefit observations. Nephrol Dial Transplant 2003;18(suppl 2):ii2–ii6.
  50. Valderabano F, Horl W, MacdougallIC, Rossert J, Rutkowski B, Wauters J-P: PRE-dialysis survey on anemia management. Nephrol Dial Transplant 2003;18:89–100.
    External Resources
  51. Fink JC, Blahut SA, Reddy M, Light PD: Use of erythropoietin before the initiation of dialysis and its impact on mortality. Am J Kidney Dis 2001;37:348–355.
    External Resources
  52. Deicher R, Horl WH: Anaemia as a risk factor for chronic kidney disease. Curr Opin Nephrol Hypertens 2003;12:139–144.
    External Resources
  53. Rossert J, Fouqueray B, Boffa J: Anemia management and the delay of chronic renal failure. J Am Soc Nephrol 2003;14:S173–S177.
  54. Levin A: The relationship of hemoglobin level and survival: Direct or indirect effects. Neph Dial Transplant 2002;17(suppl 5):8–13.
  55. Keane WF, Brenner BM, de Zeeuw D, et al: The risk of developing end-stage renal disease in patients with type 2 diabetes and nephropathy: The RENAAL Study. Kidney Int 2003;63:1499–1507.
    External Resources
  56. Silverberg DS, Wexler D, Sheps D, et al: The effect of correction of mild anemia in severe, resistant congestive heart failure using subcutaneous erythropoietin and intravenous iron: A randomized controlled study. J Am Coll Cardiol 2001;37:1775–1780.
    External Resources
  57. Silverberg DS, Wexler D, Blum M, et al: The effect of correction of anemia in diabetic and non diabetics with severe resistant congestive heart failure and chronic renal failure by subcutanous erythropoietin and intravenous iron. Nephrol Dial Transplant 2003;18:141–146.
    External Resources
  58. Mancini DM, Katz SD, Lang C, et al: Effect of erythropoietin on exercise capacity in patients with moderate to severe chronic heart failure. Circulation 2003;107:294–299.
    External Resources
  59. Aaparo MS, Cella D, Zagari M: Age, anemia and fatigue. Semin Oncol 2002;29(suppl 8):55–59.
  60. Anker SD, Sharma R: The syndrome of cardiac cachexia. Int J Cardiol 2002;85:51–66.
    External Resources
  61. Daneryd P: Epoetin alpha for protection of metabolic and exercise capacity in cancer patients. Semin Oncol 2002;29(suppl 8):69–74.
  62. Iverson PO, Woldbaek PR, Tonnessen T, Christensen G: Decreased hematopoiesis in bone marrow of mice with congestive heart failure. Am J Physiol Regul Integr Comp Physiol 2002;282:R166–172.
  63. Herrera-Garza EH, Stetson SJ, Cubillos-Garzon A, Vooltich MT, Farmer JA, Torre-Amione G: Tumor necrosis factor: A mediator of disease progression in the failing human heart. Chest 1999;115:1170–1174.
    External Resources
  64. Means RT: Advances in the anemia of chronic disease. Int J Hematol 1999;70:7–12.
    External Resources
  65. Vaziri ND: Erythropoietin and transferrin metabolism in nephrotic syndrome. Am J Kidney Dis 2001;38:1–8.
    External Resources
  66. Macdougall IC: The role of ACE inhibitors and angiotensin II receptor blockers in the response to erythropoietin. Nephrol Dial Transplant 1999;14:1836–1841.
    External Resources
  67. Hillege HL, van Gilst W, Kingma J, et al: Myocardial infarction is associated with renal function loss which is counteracted by ACE inhibition. J Am Soc Nephrol 1999;10:384A.
  68. Hillege HL, van Gilst WH, van Veldhuisen DJ, et al: Accelerated decline and prognostic impact of renal function after myocardial infarction and the benefits of ACE inhibition: The CATS randomized trial. Eur J Heart Fail 2003;24:412–420.
  69. Obrador GT, Pereira BJG, Kausz AT: Chronic kidney disease in the United States. Semin Nephrol 2002;22:441–448.
    External Resources
  70. McLellan WC, Ramirez SPR, Jurkovitz C: Screening for kidney disease: Unresolved problems. J Am Soc Nephrol 2003;14:S81–S87.
  71. Fine L, Dandyopadhay D, Norman JT: Is there a common mechanism for the progression of different types of renal diseases other than proteinuria? Towards the unifying theme of chronic hypoxia. Kidney Int 2000;57(suppl 75):S22–S26.
  72. Amann K, Ritz C, Adamczak M, Ritz E: Why is coronary heart disease of uraemic patients so frequent and so devastating? Nephrol Dial Transplant 2003;18:631–640.
  73. Tyralla K, Amann K: Morphology of the heart and arteries in renal failure. Kidney Int 2003;63(suppl 84):S80–S83.
  74. Zoccali C, Mallamaci F, Tripepi G: Traditional and emerging cardiovascular risk factors in end-stage renal disease. Kidney Int 2003;63(suppl 85):S105–S110.
  75. McCullough PA: Why is chronic kidney disease the ‘spoiler’ for cardiovascular disease outcomes? J Am Coll Cardiol 2003;41:725–728.
  76. Stenvinkel P, Pecoits-Filho R, Lindholm B: Coronary artery disease in end-stage renal disease: No longer a simple plumbing question. J Am Soc Nephrol 2003;14:1927–1939.
    External Resources
  77. Herzog CA, Ma JZ, Collins AJ: Poor long term survival after acute myocardial infarction among patients on long term dialysis. N Engl J Med 1998;339:799–805.
    External Resources
  78. Silverberg DS, Wexler D, Blum M, Iaina A: The cardio renal anemia syndrome: Correcting anemia inpatients with resistant congestive heart failure can improve both cardiac and renal function and reduces hospitalization. Clin Nephrol 2003;60(suppl 1):S93–S102.

Article / Publication Details

First-Page Preview
Abstract of Review

Received: January 23, 2004
Accepted: March 12, 2004
Published online: July 09, 2004
Issue release date: May 2004

Number of Print Pages: 8
Number of Figures: 0
Number of Tables: 0

ISSN: 0253-5068 (Print)
eISSN: 1421-9735 (Online)

For additional information: https://www.karger.com/BPU

Copyright / Drug Dosage / Disclaimer

Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

Article Tools
Article Details

2004, Vol.22, No. 3

May 2004

Article

Recommend This
TOP