Anaemia Correction Improves Cardiac and Renal Function in Patients with Congestive Heart Failure

Controlling anaemia in patients with congestive heart failure (CHF) might help improve cardiac function and prevent progressive renal failure.

In 2000, Donald S. Silverberg, MD, with the Department of Nephrology and Cardiology at Tel Aviv Sourasky Medical Centre, Israel, and colleagues examined records of 142 patients seen in an outpatient CHF clinic. They found that aggressive use of antihypertensives, aldospirone, digoxin, nitrates and oral and furosemide did not improve severe fluid retention, extreme fatigue, or New York Heart Association (NYHA) functional class in these patients.

They point out that these and other studies suggest that the failing or ischaemic heart may be “very sensitive to even minimal falls in Hb.” In addition, “anaemia may worsen and precipitate severe CHF and/or ischaemia in these patients at Hb levels that one might generally consider ‘normal’, such as 11g/dL.”

Anaemia is frequently encountered in patients with CHF and may be partly due to haemodilution, associated reduction in renal function, and use of ACE inhibitors and aspirin. The researchers also suggest that CHF alone may reduce bone marrow and cause anaemia through excessive cytokine production.

Studies investigating correction of anaemia with erythropoietin with or without the addition of intravenous iron have shown marked improvement in patients’ NYHA functional cardiac class and left ventricular ejection fraction. Need for hospitalisation and diuretics is reduced and exercise capacity and quality of life are improved. Furthermore, correction of anaemia has been found to stabilize serum creatinine levels.

Concerns about correcting anaemia in CHF patients include cost of erythropoietin and safety. In addition, data from large placebo- controlled double-blind intervention trials where anaemia is corrected with erythropoietin with or without intravenous iron are lacking.

“Until such studies are available we will not know for certain at what level of haemoglobin anaemic CHF patients should start treatment with erythropoietin and what level of haemoglobin we should aim for,” they write.

Clin Nephrol 2003;60 Suppl 1:S93-102.