Anemia and cardiovascular and kidney disease.
OBJECTIVE
The joint occurrence of cardiovascular disease, kidney disease and anemia has been termed the 'cardio-renal-anemia syndrome'. This review will examine each of these relationships as they pertain to coronary heart disease.


RESULTS
Important contributions from the recent literature included observations suggesting that African-Americans with chronic kidney disease and no previous history of cardiovascular disease were more likely than caucasians to have incident cardiovascular disease than caucasians with chronic kidney disease but that this difference did not apply to risk of recurrent cardiovascular disease. Recent reports have brought attention to a continued lack of clinical trials evidence to support anemia treatment for cardioprotection, further concern that higher hemoglobin levels may increase cardiovascular risk and evidence that anemia and kidney function interact to increase risk for coronary heart disease. Finally, additional observational studies and small clinical trials continue to support a role of anemia treatment in protection of residual kidney function, although a recent meta-analysis failed to demonstrate a conclusive benefit of erythropoietin treatment on progressive kidney disease.


CONCLUSIONS
The cardio-renal-anemia syndrome is a set of complex and interrelated phenomena that are poorly understood. Current evidence is insufficient to demonstrate a conclusive benefit of treatment with erythropoietin on risk of cardiovascular disease or progression of kidney disease. Future research is needed to further clarify these issues.
Department of Medicine, Division of Cardiology, Rollins School of Public Health, Division of Nephrology, Emory University, Atlanta, Georgia 30322, USA.
Claudine
C
Jurkovitz
Jerome
J
Abramson
William M
WM
McClellan
D000328:Adult; D017677:Age Distribution; D000368:Aged; D000740:Anemia / Q000175:diagnosis / Q000453:epidemiology*; D015897:Comorbidity; D003324:Coronary Artery Disease / Q000175:diagnosis / Q000453:epidemiology*; D005260:Female; D006334:Heart Function Tests; D006403:Hematologic Tests; D006801:Humans; D007676:Kidney Failure, Chronic / Q000175:diagnosis / Q000453:epidemiology*; D007677:Kidney Function Tests; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011379:Prognosis; D018570:Risk Assessment; D012720:Severity of Illness Index; D017678:Sex Distribution; D016019:Survival Analysis