#PAGE_PARAMS# #ADS_HEAD_SCRIPTS# #MICRODATA#

Anaemia in chronic heart failure


Authors: J. Hradec
Authors‘ workplace: III. interní klinika 1. lékařské fakulty UK a VFN Praha, přednosta prof. MUDr. Štěpán Svačina, DrSc., MBA
Published in: Vnitř Lék 2010; 56(8): 854-859
Category: 50th Birthday - Jindřich Špinar, MD, CSc., FESC

Overview

Anaemia is a relatively frequent co–morbidity of chronic heart as well as chronic renal failure. In both conditions, it represents a strong and independent predictor of increased morbidity and mortality. Aetiology of this anaemia is multi‑factorial. A number of various factors play a role in its development, e. g. inadequate erythropoietin production in the kidneys, bone marrow inhibition, iron deficiency as well as haemodilution associated with fluid retention. Treatment strategies aim at two directions. One is the stimulation of erythropoiesis with recombinant human erythropoietin or its analogues such as darbepoetin α. The other involves iron substitution, administered preferably intravenously for improved efficacy and tolerability. Clinical studies evaluating treatment of anaemia in chronic heart failure with erythropoiesis-stimulating agents conducted so far were of a small scale, were not controlled with placebo and usually assessed proxy parameters. Their results suggested that effective treatment of anaemia in patients with chronic heart failure improves exertion tolerance, clinical status (NYHA class) as well as the quality of life and reduces the need for blood transfusions. Recently completed TREAT study was the first large morbidity and mortality study evaluating treatment of anaemia with an erythropoietin analogue compared to placebo. On a sample of more than 4000 patients with diabetes mellitus, chronic renal failure and significant anaemia, this study has shown that effective treatment of anaemia with darbepoetin α did not affect at all the incidence of cardiovascular and renal events; on the other hand, it had lead to a nearly two‑fold increase in the incidence of cerebrovascular events. Some doubts about the safety of treatment with erythropoiesis-stimulating agents have occurred in the past based on the studies of anaemia treatment in patients with cancer and renal diseases. An answer to the question whether the treatment of anaemia associated with chronic heart failure affects positively the patient prognosis will be provided following the completion of the currently running morbidity and mortality RED-HF study.

Key words:
anaemia – chronic heart failure – chronic renal failure – erythropoiesis-stimulating agents – iron – clinical study FAIR-HF – clinical study TREAT


Sources

1. Tang YD, Katz SD. Anemia in chronic heart failure: prevalence, etiology, clinical correlates, and treatment options. Circulation 2006; 113: 2454–2461.

2. Komajda M, Anker SD, Charlesworth A et al. The impact on new onset anaemia on morbidity and mortality in chronic heart failure: results from COMET. Eur Heart J 2006; 27: 1440–1446.

3. van der Meer P, Voors AA, Lipsic E et al. Erythropoietin in cardiovascular diseases. Eur Hert J 2004; 25: 285–291.

4. Westenbrink BD, Visser FW, Voors AA et al. Anaemia in chronic heart failure is not only related to impaired renal perfusion and blunted erythropoietin production, but to fluid retention as well. Eur Heart J 2007; 28: 166–171.

5. van der Harst P, van der Steege G, de Boer RA et al. Telomere length of circulating leukocytes is decreased in patients with chronic heart failure. J Am Coll Cardiol 2007; 49: 1459–1464.

6. Nanas JN, Matsouka C, Karageorgopoulos D et al. Etiology of anemia in patients with advanced heart failure. J Am Coll Cardiol 2006; 48: 2485–2489.

7. Westenbrink BD, de Boer RA, Voors AA et al. Anemia in chronic heart failure: etiology and treatment options. Curr Opin Cardiol 2008; 23: 141–147.

8. 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.

9. Ghali JK, Anand IS, Abraham WT et al. STAMINA‑HeFT group. Randomized double‑blind trial of darbepoetin alfa in patients with symptomatic heart failure and anemia. Circulation 2008; 117: 526–535.

10. Ponikowski P, Anker SD, Szachniewicz Jet al. Effect of darbepoetin alfa on exercise tolerance in anemic patients with symptomatic chronic heart failure: a randomized, double‑blind, placebo‑controlled trial. J Am Coll Cardiol 2007; 49: 753–762.

11. van Veldhuisen DJ, Dickstein K, Cohen‑-Solal A et al. Randomized, double‑blind, placebo‑controlled study to evaluate the effect of two dosing regimens of darbepoetin alfa in patients with heart failure and anaemia. Eur Heart J 2007; 28: 2208–2216.

12. van der Meer P, Groenveld HF, Januzzi JL Jr et al. Erythropoietin treatment in patients with chronic heart failure: a meta‑analysis. Heart 2009; 95: 1309–1314.

13. Anker SD Comin-Colet J, Filipptos G et al. FAIR‑HF Trial Investigators. Ferric carboxymaltose in patients with heart failure and iron deficiency. N Engl J Med 2009; 361: 2436–2448.

14. Beck da Silva L, Rohde LE, Pereira‑Barretto AC et al. Rationale and design of the IRON‑HF study: a randomized trial to assess the effect of iron supplementation in heart failure patients with anemia. J Card Fail 2007; 13: 14–17.

15. Besarab A, Bolton WK, Browne JK et al. The effects of normal as compared with low hematocrit values in patients with cardiac disease who are receiving hemodialysis and epoetin. N Engl J Med 1998; 339: 584–590.

16. Steinbrook R. Erythropoietin, the FDA, and oncology. N Engl J Med 2007; 356: 2448–2451.

17. Singh AK, Szczech L, Tang KL et al. CHOIR Investigators. Correction of anemia with epoetin alfa in chronic kidney disease. N Engl J Med 2006; 355: 2085–2098.

18. Drüeke TB, Locatelli G, Clyne N et al. CREATE Investigators. Normalization of haemoglobin level in patients with chronic kidney disease and anemia. N Engl J Med 2006; 355: 2071–2084.

19. Pfeffer MA, Burdmann EA, Chen CY et al. A trial of darbepoetin alfa in type 2diabetes and chronic kidney disease. N Engl J Med 2009; 361: 2019–2032.

20. McMurray JJ, Anand IS, Diaz R et al. Design of the Reduction of Events with Darbepoetin alfa in Heart Failure (RED‑HF): a phase III, anaemia correction, morbidity‑mortality trial. Eur J Heart Fail 2009; 11: 795–801.

Labels
Diabetology Endocrinology Internal medicine

Article was published in

Internal Medicine

Issue 8

2010 Issue 8

Most read in this issue
Topics Journals
Login
Forgotten password

Enter the email address that you registered with. We will send you instructions on how to set a new password.

Login

Don‘t have an account?  Create new account

#ADS_BOTTOM_SCRIPTS#