title: Anaemia in chronic heart failure is not only related to impaired renal perfusion and blunted erythropoietin production, but to fluid retention as well.
abstract: OBJECTIVE
  Anaemia is prevalent in the chronic heart failure (CHF) population, but its cause is often unknown. The present study aims to investigate the relation between anaemia, renal perfusion, erythropoietin production, and fluid retention in CHF patients.
  
  
  RESULTS
  We studied 97 patients with CHF, of which 15 had anaemia (Hb<13.0 g/dL in men and Hb<12.0 g/dL in women), without haematinic deficiencies. Glomerular filtration rate (GFR) and extracellular volume (ECV) were measured as the clearance and the distribution volume of constantly infused 125I-iothalamate, respectively. Effective renal plasma flow (ERPF) was determined as the clearance of 131I-hippuran. Anaemic CHF patients displayed significantly reduced GFR (P=0.002), ERPF (P=0.005) and EPO production (P=0.001), and an elevated ECV (P=0.015). Multivariable analysis demonstrated that lower GFR (P=0.003), lower ERPF (P=0.004), lower EPO production (P=0.006), and a higher ECV (P=0.001) were significant independent predictors of lower haemoglobin levels.
  
  
  CONCLUSIONS
  Anaemia in CHF is not only independently associated with impaired renal perfusion and blunted EPO production, but to fluid retention as well.
authors.affiliation: Department of Cardiology, University Medical Center Groningen, University of Groningen, The Netherlands. b.d.westenbrink@thorax.umcg.nl
authors.forename: B Daan
authors.initials: BD
authors.lastname: Westenbrink
authors.forename: Folkert W
authors.initials: FW
authors.lastname: Visser
authors.forename: Adriaan A
authors.initials: AA
authors.lastname: Voors
authors.forename: Tom D J
authors.initials: TD
authors.lastname: Smilde
authors.forename: Erik
authors.initials: E
authors.lastname: Lipsic
authors.forename: Gerjan
authors.initials: G
authors.lastname: Navis
authors.forename: Hans L
authors.initials: HL
authors.lastname: Hillege
authors.forename: Wiek H
authors.initials: WH
authors.lastname: van Gilst
authors.forename: Dirk J
authors.initials: DJ
authors.lastname: van Veldhuisen
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000740:Anemia / Q000209:etiology*; D048429:Cell Size; D002908:Chronic Disease; D004921:Erythropoietin / Q000378:metabolism*; D005260:Female; D006333:Heart Failure / Q000150:complications* / Q000378:metabolism; D006454:Hemoglobins / Q000378:metabolism; D006801:Humans; D007674:Kidney Diseases / Q000150:complications* / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D012079:Renal Circulation / Q000502:physiology; D017596:Renal Plasma Flow, Effective / Q000502:physiology; D014883:Water-Electrolyte Imbalance / Q000150:complications*
chemical_list: D006454:Hemoglobins; D004921:Erythropoietin