Aggressive Therapy of Congestive Heart Failure and Associated Chronic Renal Failure with Medications and Correction of Anemia Stops or Slows the Progression of Both Diseases

Abstract

The prevalence of congestive heart failure (CHF) is increasing rapidly in the community. We and others have shown that the prevalence and severity of both anemia and chronic renal failure (CRF) increase steadily with increasing severity of CHF. We have also shown that CHF patients may be resistant to standard drug therapy for CHF as long as the associated anemia is not corrected, and that correction of the anemia with subcutaneous erythropoietin and intravenous iron sucrose (Venofer: Vifor International, St. Gallen, Switzerland) may improve both the CHF and CRF and markedly reduce hospitalizations without causing side effects. We report here our experience with correcting anemia in this manner in 126 cases of anemic-resistant CHF patients. As in our previous studies, correction of the anemia improved both CHF and CRF, and reduced hospitalizations. Our studies suggest that correction of even mild anemia in CHF may be an important addition to the treatment of patients with the combination of CHF and CRF.

Impact of Anemia on Hospitalization Time, Charges, and Mortality in Patients with Heart Failure

“…Similar relationships between anemia and mortality have been replicated in subsequent cohort studies [6,7]. Furthermore, treatment of anemia has been found to improve health status and reduce hospitalizations in outpatient settings [8,9]. Based on these observational studies, Silverberg et al.…”

Diabetic nephropathy and anaemia

“…In an observational study, Ezekowitz et al documented that mortality was higher in patients with congestive heart failure who had also anaemia [94]. Silverberg et al showed that in 126 patients with congestive heart failure, administration of rhEPO to raise the Hb concentration from 10·3 to 13·1 g dL −1 caused a dramatic decrease of the average NYHA class from 3·8 to 2·7 and the rate of hospitalization from 3·7 to 0·2 per year [95]. Recently, similar improvement was also documented in diabetic patients [96].…”

Prognostic significance of hemoglobin level in patients with congestive heart failure and normal ejection fraction

“…[9][10][11][12][13][14][15] Several small studies have shown benefit with the correction of anemia with erythropoietin and iron in these patients. [16][17][18][19][20][21] Although frequency and prognostic implications of anemia have been investigated in patients with CHF and reduced EF, few data exist in those with normal EF, although 30-50% of patients with CHF have normal EF. [22][23][24][25][26] We investigated the effect of anemia on survival in patients with CHF and normal EF compared with those with reduced EF.…”