title: Anemia, renal dysfunction, and their interaction in patients with chronic heart failure.
abstract: Anemia and renal dysfunction (RD) are frequent complications seen in chronic heart failure (HF). However, the prevalence and interaction of these co-morbidities in a representative population of outpatients with chronic HF is poorly described. In this study, it was sought to determine the association between RD and anemia in patients with HF enrolled in a community-based HF program. Nine hundred fifty-five patients with HF due to left ventricular systolic dysfunction were investigated for the prevalence of anemia and its cause and followed for a median of 531 days. Anemia was defined as hemoglobin < 12.0 g/dl in women and < 13.0 g/dl in men. RD was defined as a calculated glomerular filtration rate of < 60 ml/min. The prevalence of anemia was 32%. Fifty-three percent of patients with and 27% of those without anemia had > or = 1 test suggesting hematinic deficiency. The prevalence of RD was 54%. Forty-one percent of patients with and 22% of patients without RD had anemia, with similar proportions associated with iron deficiency in the presence or absence of RD. Anemia and RD independently predicted a worse outcome, and this effect was additive. In conclusion, in outpatients with chronic HF, anemia and RD are common and co-exist but confer independent prognostic information. A deficiency of conventional hematinic factors may cause about 1/3 of anemia in this clinical setting.
authors.affiliation: Academic Cardiology, University of Hull, Castle Hill Hospital, Cottingham, United Kingdom. ramesh@desilva84.freeserve.co.uk
authors.forename: Ramesh
authors.initials: R
authors.lastname: de Silva
authors.forename: Alan S
authors.initials: AS
authors.lastname: Rigby
authors.forename: Klaus K A
authors.initials: KK
authors.lastname: Witte
authors.forename: Nikolay P
authors.initials: NP
authors.lastname: Nikitin
authors.forename: Lwin
authors.initials: L
authors.lastname: Tin
authors.forename: Kevin
authors.initials: K
authors.lastname: Goode
authors.forename: Sunil
authors.initials: S
authors.lastname: Bhandari
authors.forename: Andrew L
authors.initials: AL
authors.lastname: Clark
authors.forename: John G F
authors.initials: JG
authors.lastname: Cleland
mesh_terms: D000368:Aged; D000740:Anemia / Q000097:blood / Q000453:epidemiology / Q000209:etiology*; D002908:Chronic Disease; D018450:Disease Progression; D005260:Female; D005293:Ferritins / Q000097:blood; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D006333:Heart Failure / Q000150:complications* / Q000401:mortality / Q000503:physiopathology; D006454:Hemoglobins / Q000378:metabolism; D006801:Humans; D008297:Male; D009200:Myocardial Contraction / Q000502:physiology; D015995:Prevalence; D011379:Prognosis; D051437:Renal Insufficiency / Q000453:epidemiology / Q000209:etiology* / Q000503:physiopathology; D012189:Retrospective Studies; D015996:Survival Rate
chemical_list: D006454:Hemoglobins; D005293:Ferritins