title: Managing anemia in patients with chronic heart failure: what do we know?
abstract: Anemia is common in patients with chronic heart failure (HF) with an incidence ranging from 4% to 55% depending on the studied population. Several studies have highlighted that the prevalence of anemia increases with worsening heart failure as reflected by New York Heart Association classification. Additionally, several epidemiological studies have highlighted its role as a prognostic marker, linking it to worse outcomes including; malnutrition, increased hospitalizations, refractory heart failure and death. The pathophysiology of anemia is multifactorial and related to various factors including; hemodilution, iron losses from anti-platelet drugs, activation of the inflammatory cascade, urinary losses of erythropoietin and associated renal insufficiency. There are a host of epidemiological studies examining HF outcomes and anemia, but only a few randomized trials addressing this issue. The purpose of this article is to review the literature that examines the interrelationship of anemia and congestive HF, analyzing its etiology, impact on outcomes and also the role of associated kidney disease as well as cardiorenal syndrome both as a marker of morbidity and mortality.
authors.affiliation: Division of Nephrology, Henry Ford Health System, Detroit, Michigan 48202, USA.
authors.forename: Ankur
authors.initials: A
authors.lastname: Sandhu
authors.forename: Sandeep
authors.initials: S
authors.lastname: Soman
authors.forename: Michael
authors.initials: M
authors.lastname: Hudson
authors.forename: Anatole
authors.initials: A
authors.lastname: Besarab
mesh_terms: D000740:Anemia / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D002908:Chronic Disease; D004921:Erythropoietin / Q000097:blood; D006333:Heart Failure / Q000097:blood / Q000150:complications* / Q000401:mortality; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications / Q000401:mortality / Q000628:therapy; D006435:Renal Dialysis
chemical_list: D004921:Erythropoietin
references.citation: Circulation. 2008 Jan 29;117(4):526-35
references.pmid: 18195176
references.citation: Eur Heart J. 1987 Sep;8 Suppl F:23-6
references.pmid: 3665963
references.citation: J Heart Lung Transplant. 1994 Jul-Aug;13(4):S107-12
references.pmid: 7947865
references.citation: Am J Med. 2004 Apr 1;116(7):466-73
references.pmid: 15047036
references.citation: Hemodial Int. 2007 Jan;11(1):1-14
references.pmid: 17257349
references.citation: Am J Cardiol. 1991 Feb 1;67(4):295-9
references.pmid: 1825011
references.citation: Kidney Int Suppl. 2003 Nov;(87):S24-31
references.pmid: 14531770
references.citation: N Engl J Med. 2001 Nov 15;345(20):1435-43
references.pmid: 11794191
references.citation: Isr Med Assoc J. 2003 May;5(5):337-9
references.pmid: 12811950
references.citation: Am Heart J. 2005 Mar;149(3):408-13
references.pmid: 15864229
references.citation: Kidney Int. 1995 Mar;47(3):884-90
references.pmid: 7752588
references.citation: Rev Cardiovasc Med. 2003;4 Suppl 7:S21-30
references.pmid: 14668697
references.citation: Int J Cardiol. 2002 Nov;86(1):115-21
references.pmid: 12400591
references.citation: J Am Coll Cardiol. 2008 Nov 4;52(19):1527-39
references.pmid: 19007588
references.citation: N Engl J Med. 1992 Sep 3;327(10):685-91
references.pmid: 1463530
references.citation: Nat Clin Pract Nephrol. 2008 Jun;4(6):310-1
references.pmid: 18398412
references.citation: Am Heart J. 1999 May;137(5):919-27
references.pmid: 10220642
references.citation: Am J Kidney Dis. 2008 Jan;51(1 Suppl 1):S1-320
references.pmid: 18086389
references.citation: J Am Coll Cardiol. 2004 Apr 21;43(8):1432-8
references.pmid: 15093880
references.citation: Kidney Int. 2008 Sep;74(6):791-8
references.pmid: 18596733
references.citation: Am J Kidney Dis. 2001 Oct;38(4 Suppl 1):S26-9
references.pmid: 11576917
references.citation: Circulation. 2003 Jan 21;107(2):226-9
references.pmid: 12538419
references.citation: Can J Cardiol. 2007 Jan;23(1):21-45
references.pmid: 17245481
references.citation: N Engl J Med. 2006 Nov 16;355(20):2085-98
references.pmid: 17108343
references.citation: Eur Heart J. 2007 Sep;28(18):2208-16
references.pmid: 17681958
references.citation: Am J Kidney Dis. 1999 Jul;34(1):125-34
references.pmid: 10401026
references.citation: Am J Kidney Dis. 2001 Sep;38(3):510-7
references.pmid: 11532682
references.citation: Am J Cardiol. 2003 Apr 1;91(7):888-91
references.pmid: 12667582
references.citation: Int J Cardiol. 2003 Aug;90(2-3):303-8
references.pmid: 12957766
references.citation: J Nephrol. 2008 Mar-Apr;21(2):236-42
references.pmid: 18446719
references.citation: Circulation. 2003 Jan 21;107(2):294-9
references.pmid: 12538431
references.citation: J Am Coll Cardiol. 2003 Apr 16;41(8):1364-72
references.pmid: 12706933
references.citation: Clin Lab Haematol. 2001 Feb;23(1):1-6
references.pmid: 11422223
references.citation: Nephrol Dial Transplant. 2001;16 Suppl 2:7-11
references.pmid: 11369842
references.citation: Int J Cardiol. 2007 Aug 21;120(2):232-6
references.pmid: 17174420
references.citation: Circulation. 2003 Jan 21;107(2):223-5
references.pmid: 12538418
references.citation: Intensive Care Med. 2008 May;34(5):957-62
references.pmid: 18251008
references.citation: Eur J Heart Fail. 2008 Sep;10(9):819-23
references.pmid: 18703380
references.citation: Cardiol Clin. 2001 Nov;19(4):547-55
references.pmid: 11715176
references.citation: J Nephrol. 2004 Nov-Dec;17(6):749-61
references.pmid: 15593047
references.citation: J Card Fail. 2004 Dec;10(6):460-6
references.pmid: 15599835
references.citation: Blood. 1979 Oct;54(4):877-84
references.pmid: 476305
references.citation: J Am Coll Cardiol. 2005 Jul 5;46(1):125-33
references.pmid: 15992646
references.citation: Eur J Heart Fail. 2007 Feb;9(2):110-2
references.pmid: 17270493
references.citation: Am J Kidney Dis. 2001 Jul;38(1):1-8
references.pmid: 11431174
references.citation: Kidney Int. 1995 Jan;47(1):186-92
references.pmid: 7731145
references.citation: J Am Coll Cardiol. 2006 Sep 19;48(6):1225-7
references.pmid: 16979010
references.citation: J Am Soc Nephrol. 2002 Jul;13(7):1928-36
references.pmid: 12089390
references.citation: J Am Coll Cardiol. 2002 Jun 5;39(11):1780-6
references.pmid: 12039491
references.citation: J Am Soc Nephrol. 2004 Jul;15(7):1912-9
references.pmid: 15213281
references.citation: Circulation. 2006 May 23;113(20):2454-61
references.pmid: 16717164
references.citation: J Am Coll Cardiol. 2001 Jun 1;37(7):1775-80
references.pmid: 11401110
references.citation: Perit Dial Int. 2001;21 Suppl 3:S236-40
references.pmid: 11887828
references.citation: Kidney Blood Press Res. 2005;28(1):41-7
references.pmid: 15489560
references.citation: Nat Clin Pract Nephrol. 2007 Dec;3(12):637
references.pmid: 18033224
references.citation: J Am Soc Nephrol. 2005 Feb;16(2):489-95
references.pmid: 15590763
references.citation: J Am Coll Cardiol. 2008 Sep 2;52(10):818-27
references.pmid: 18755344
references.citation: Am J Kidney Dis. 2001 Oct;38(4):803-12
references.pmid: 11576884
references.citation: J Am Coll Cardiol. 2008 Aug 12;52(7):501-11
references.pmid: 18687241
references.citation: Am J Cardiol. 1999 Sep 1;84(5):611-2, A9
references.pmid: 10482169
references.citation: Cardiol Rev. 2006 May-Jun;14(3):108-24
references.pmid: 16628020
references.citation: Am J Kidney Dis. 2000 Apr;35(4 Suppl 1):S117-31
references.pmid: 10766010
references.citation: J Am Coll Cardiol. 2001 Oct;38(4):955-62
references.pmid: 11583864
references.citation: Am J Med. 2003 Feb 1;114(2):112-9
references.pmid: 12586230
references.citation: World Health Organ Tech Rep Ser. 1968;405:5-37
references.pmid: 4975372
references.citation: Herz. 2001 Nov;26(7):437-46
references.pmid: 11765476
references.citation: Am J Cardiol. 2004 Apr 15;93(8):1055-7
references.pmid: 15081458
references.citation: N Engl J Med. 1998 Aug 27;339(9):584-90
references.pmid: 9718377
references.citation: Circulation. 2000 Jul 11;102(2):203-10
references.pmid: 10889132
references.citation: Circulation. 2004 Mar 2;109(8):1004-9
references.pmid: 14769700
references.citation: J Am Coll Cardiol. 1996 Apr;27(5):1201-6
references.pmid: 8609343
references.citation: Am Heart J. 2007 Nov;154(5):870-6
references.pmid: 17967592
references.citation: J Am Coll Cardiol. 2004 Jul 7;44(1):63-7
references.pmid: 15234408
references.citation: J Card Fail. 2007 Jun;13(5):360-4
references.pmid: 17602982
references.citation: Circulation. 2005 Aug 23;112(8):1121-7
references.pmid: 16103233
references.citation: Clin Nutr. 2004 Jun;23(3):355-61
references.pmid: 15158299
references.citation: Semin Nephrol. 2001 Mar;21(2):190-203
references.pmid: 11245780
references.citation: Heart. 2009 Aug;95(16):1309-14
references.pmid: 19168472
references.citation: Am J Physiol Regul Integr Comp Physiol. 2002 Jan;282(1):R166-72
references.pmid: 11742835
references.citation: J Am Coll Cardiol. 2000 Jun;35(7):1737-44
references.pmid: 10841219
references.citation: Am J Cardiol. 1994 Sep 1;74(5):468-73
references.pmid: 8059727
references.citation: Eur Heart J. 2001 Apr;22(8):623-6
references.pmid: 11286518
references.citation: J Am Coll Cardiol. 2003 Jun 4;41(11):1933-9
references.pmid: 12798560
references.citation: J Card Fail. 2004 Dec;10(6):467-72
references.pmid: 15599836
references.citation: J Am Coll Cardiol. 2006 Dec 19;48(12):2485-9
references.pmid: 17174186
references.citation: J Card Fail. 2002 Jun;8(3):136-41
references.pmid: 12140805
references.citation: Br Heart J. 1993 Oct;70(4):357-62
references.pmid: 8217445
references.citation: N Engl J Med. 1999 Feb 11;340(6):409-17
references.pmid: 9971864
references.citation: J Am Coll Cardiol. 2007 Oct 23;50(17):1657-65
references.pmid: 17950147
references.citation: Am J Kidney Dis. 1996 Mar;27(3):347-54
references.pmid: 8604703
references.citation: J Am Coll Cardiol. 2000 Mar 1;35(3):681-9
references.pmid: 10716471
references.citation: Am J Kidney Dis. 1996 Jul;28(1):53-61
references.pmid: 8712222
references.citation: Nephrol Dial Transplant. 2003 Jan;18(1):141-6
references.pmid: 12480972
references.citation: J Am Coll Cardiol. 2006 May 16;47(10):1987-96
references.pmid: 16697315
references.citation: Am J Kidney Dis. 2007 Sep;50(3):471-530
references.pmid: 17720528
references.citation: J Am Coll Cardiol. 2005 Jul 5;46(1):57-64
references.pmid: 15992636
references.citation: Blood. 1989 Jul;74(1):130-8
references.pmid: 2752104
references.citation: Heart. 2005 Jul;91(7):907-13
references.pmid: 15958359
references.citation: JAMA. 2004 Oct 6;292(13):1555-62
references.pmid: 15467057