Cardiorenal Anemia Syndrome and Survival among Heart Failure Patients in Tanzania: A Prospective Cohort Study

Abstract

BackgroundCardiorenal anemia syndrome (CRAS) is an evolving global epidemic associated with increased morbimortality and cost of care. The management of patients with CRAS remains a challenging undertaking worldwide and the lack of evidence-based clinical guidelines adds to the challenge. We aimed to explore the prevalence and survival rates of heart failure patients with CRAS in Tanzania.MethodsWe screened 789 patients and consecutively recruited 463 who met the inclusion criteria. Each participant underwent an interview, physical examination, anthropometric measurements, anemia, renal functions and echocardiographic assessment. All participants were followed until death or for up-to 180 days, whichever came first. Bivariate comparison and subsequent Cox proportional-hazards regression model were used to compare the CRAS and non-CRAS groups with respect to the primary end point.ResultsThe mean age of participants was 46.4 ± 18.9 years, and 56.5% were women. Overall, 51.9% of participants had renal insufficiency, 72.8% were anemic and 44.4% had CRAS. During a mean follow-up of 103 ± 75 days, 57.8% of participants died. Patients with CRAS displayed a higher mortality rate (73.5%) compared to those free of CRAS (45.8%), (p < 0.001). During multivariate analysis in a cox regression model of 21 potential predictors of mortality; renal dysfunction (HR 1.9; 95% CI 1.0–3.5; p = 0.03), severe anemia (HR 1.8; 95% CI 1.0–3.1; p = 0.04), hyponatremia (HR 2.2; 95% CI 1.3–3.7; p = 0.004) and rehospitalization (HR 4.3; 95% CI 2.2–8.4; p < 0.001) proved to be the strongest factors.ConclusionCardiorenal anemia syndrome is considerably prevalent and is associated with an increase in mortality amongst patients with heart failure. In view of this, timely, aggressive and collaborative measures to improve renal functions and/or correct anemia are crucial in the management of CRAS patients. Furthermore, these findings call for guideline committees to revise and/or develop evidence-based recommendations for management of patients with CRAS.Electronic supplementary materialThe online version of this article (doi:10.1186/s12872-017-0497-2) contains supplementary material, which is available to authorized users.

Incidence and impact of cardiorenal anaemia syndrome on all‐cause mortality in acute heart failure patients stratified by left ventricular ejection fraction in the Middle East

“…11 From a Canadian population-based study of new onset HF, 3% (362/12 065) of the patients had CRAS. 13 In another study, 22% (210/955) of the patients had CRAS. 13 In another study, 22% (210/955) of the patients had CRAS.…”

“…12 In a small Tanzanian study, they found that 44% (202/455) of the patients had CRAS. 13 In another study, 22% (210/955) of the patients had CRAS. 14 In our study, we found that 27% patient population comes under the CRAS category, which is almost double the results we obtained from CHARM trial.…”

“…[11][12][13][14] In Candesartan in Heart Failure-Assessment of Reduction in Mortality and Morbidity (CHARM) trial, 14% (371/2653) of the patients were identified to have CRAS. [11][12][13][14] In Candesartan in Heart Failure-Assessment of Reduction in Mortality and Morbidity (CHARM) trial, 14% (371/2653) of the patients were identified to have CRAS.…”

“…Incidence of CRAS varies from 3% to 44.4%. [11][12][13][14] In Candesartan in Heart Failure-Assessment of Reduction in Mortality and Morbidity (CHARM) trial, 14% (371/2653) of the patients were identified to have CRAS. 11 From a Canadian population-based study of new onset HF, 3% (362/12 065) of the patients had CRAS.…”

Medication adherence and survival among hospitalized heart failure patients in a tertiary hospital in Tanzania: a prospective cohort study

“…Cardiovascular disorders (CVD) are responsible for about one-third of all global mortality with over threequarters of deaths transpiring in the developing world [1]. In spite of the remarkable advances in novel screening techniques and therapeutic directions, the prognosis of heart failure (HF) remains strikingly poor around the globe particularly in the developing nations [2][3][4][5][6][7]. Owing to its chronic nature, clinical management of HF necessitate long-term use of several drugs to reduce morbidity [8][9][10] and mortality [11][12][13].…”