Anemia management in an outpatient heart failure center

Novak, Beverly; Sumodi, Veronica; Bynane, Margaret; Fagnilli, Karen; Hanna, Michael A.; Hixson, E L

doi:10.1016/s1071-9164(03)00188-x

Cited by 7 publications

(8 citation statements)

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“…The finding that the NYHA functional status and cardiac function improved with therapy is consistent with our previous studies of anaemia treatment in CHF [9,[11][12][13], and with findings from other groups [14][15][16]. In a randomized controlled study by Mancini et al, the investigators evaluated anaemia correction with epoetin along with oral iron, if required, over a 3-month period [14].…”

Section: Discussionsupporting

confidence: 86%

“…Indeed, hospital expenses were 19.9% less for a Hct of 636% compared with an Hct of !33% [27]. In the present study, as in our previous studies of CHF [9,[11][12][13] and two recent intervention studies of anaemia treatment with epoetin in CHF patients [15,16], it would appear that the correction of the anaemia reduces hospitalizations, but as with the effect on mortality, this must await confirmation by large randomized controlled studies.…”

Section: Discussionsupporting

confidence: 64%

“…In a recent randomized controlled study of epoetin treatment CKD patients, correction of anaemia was associated with a decrease in the progression of the CKD and a marked reduction in the need to initiate dialysis [32]. Similarly, two recent preliminary studies of epoetin in CHF have also shown an improvement in renal function with anaemia treatment [15,16]. Hypoxia is known to promote the progression of renal failure [33].…”

Section: Discussionmentioning

confidence: 99%

“…Several controlled and uncontrolled studies have demonstrated an association between anaemia treatment, with recombinant human erythropoietin (epoetin) and oral or i.v. iron, and improvements in functional capacity [9][10][11]13], cardiac function [9,[11][12][13][14] and quality of life (QoL) [14], a stabilization or improvement in renal function [9, 11-13, 15, 16], and a reduction in hospitalizations [9][10][11][12][13][15][16] and diuretic doses [9,[11][12][13]15] in patients with severe symptomatic CHF. Therefore, anaemia may be an independent risk factor, contributing to the severity of CHF.…”

Section: Introductionmentioning

confidence: 99%

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Effects of Treatment with Epoetin Beta on Outcomes in Patients with Anaemia and Chronic Heart Failure

Silverberg

Wexler

Blum

et al. 2005

Kidney Blood Press Res

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Anaemia is frequently found in patients with chronic heart failure (CHF) and has been associated with an increase in mortality and morbidity, impaired cardiac and renal function and a reduced quality of life (QoL) compared with non-anaemic CHF patients. Correction of anaemia with recombinant human erythropoietin (epoetin) has been associated with an improvement in CHF in both controlled and uncontrolled studies. The present study describes our findings in a series of 78 consecutive patients with symptomatic CHF and anaemia (haemoglobin (Hb) level <12.0 g/dl) treated with epoetin beta and, if necessary, intravenous iron sucrose. Over a mean observation period of 20.7 ± 12.1 months, mean Hb levels increased from 10.2 ± 1.1 to 13.5 ± 1.2 g/dl, p < 0.01. New York Heart Association (NYHA) functional class, left ventricular ejection fraction (LVEF) were significantly improved and the number of hospitalizations was significantly reduced with the period before treatment (all p < 0.01). Serum creatinine and creatinine clearance (CCr) were 2.2 ± 0.9 mg/dl and 32.5 ± 26.5 ml/min, respectively, at baseline, and remained stable over the observation period. Interestingly, >90% of the patients had concomitant mild-to-moderate chronic kidney disease at baseline and study end (CKD), as defined by the accepted diagnostic criterion of a CCr <60 ml/min. Conclusions: The correction of the anaemia with epoetin beta together with initial intravenous iron supplementation, resulted in significant improvements in NYHA class and cardiac function, and a reduction in hospitalization rate. Moreover, renal function was maintained stable in most patients.

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Section: Discussionsupporting

confidence: 86%

Section: Discussionsupporting

confidence: 64%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Effects of Treatment with Epoetin Beta on Outcomes in Patients with Anaemia and Chronic Heart Failure

Silverberg

Wexler

Blum

et al. 2005

Kidney Blood Press Res

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“…1 The interaction between congestive heart failure (CHF), chronic kidney disease (CKD) and anemia-the cardio renal anemia syndrome [14][15][16][17][18][19]. That anemia may actually be contributing to the severity of the CHF is suggested by several controlled and uncontrolled studies which we and others have carried out in which correction of the anemia in severe resistant CHF patients by subcutaneous (sc) Erythropoietin (EPO) used together with intravenous (IV) iron [14,[16][17][18][19][20]22] or oral iron [21,23] has been associated with an improvement in functional capacity and cardiac function [14,[16][17][18][19][20][21], a reduction in hospitalizations [14, 16-20, 22, 23], a stabilization or improvement in renal function [14, 16-20, 22, 23], a reduction in the dose of diuretics needed [14,[16][17][18][19][20]22] and an improvement in the quality of life (QoL) [21]. In a recent meta-analysis of 95 papers and abstracts of EPO therapy in CKD and ESKD, it was concluded that EPO therapy resulted in a reduction in left ventricular hypertrophy (LVH) parameters and in a reduction of end systolic and diastolic volumes along with an increase in the left ventricular ejection fraction (LVEF).…”

Section: Chf Ckd and Anemiamentioning

confidence: 99%

Anemia, chronic renal disease and congestive heart failure—the cardio renal anemia syndrome: the need for cooperation between cardiologists and nephrologists

Silverberg¹,

Wexler²,

Iaina³

et al. 2006

Int Urol Nephrol

105

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Many patients with congestive heart failure (CHF) fail to respond to maximal CHF therapy and progress to end stage CHF with many hospitalizations, poor quality of life (QoL), progressive chronic kidney disease (CKD) which can lead to end stage kidney disease (ESKD), or die of cardiovascular complications within a short time. One factor that has generally been ignored in many of these people is the fact that they are often anemic. The anemia in CHF is due mainly to the frequently-associated CKD but also to the inhibitory effects of cytokines on erythropoietin production and on bone marrow activity, as well as to their interference with iron absorption from the gut and their inhibiting effect on the release of iron from iron stores. Anemia itself may further worsen cardiac and renal function and make the patients resistant to standard CHF therapy. Indeed anemia in CHF has been associated with increased severity of CHF, increased hospitalization, worse cardiac function and functional class, the need for higher doses of diuretics, progressive worsening of renal function and reduced QoL. In both controlled and uncontrolled studies of CHF, the correction of the anemia with erythropoietin (EPO) and oral or intravenous (IV) iron has been associated with improvement in many cardiac and renal parameters and an increased QoL. EPO itself may also play a direct role in improving the heart unrelated to the improvement of the anemia--by reducing apoptosis of cardiac and endothelial cells, increasing the number of endothelial progenitor cells, and improving endothelial cell function and neovascularization of the heart. Anemia may also play a role in the worsening of acute myocardial infarction and chronic coronary heart disease (CHD) and in the cardiovascular complications of renal transplantation. Anemia, CHF and CKD interact as a vicious circle so as to cause or worsen each other- the so-called cardio renal anemia syndrome. Only adequate treatment of all three conditions can prevent the CHF and CKD from progressing.

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