Protective roles of erythropoiesis-stimulating proteins in chronic heart failure with anemia

Abstract

Anemia is a common comorbidity in patients with chronic heart failure (CHF) and is frequently treated with erythropoiesis-stimulating proteins (ESPs). Previous studies, however, have been relatively short in duration and have not provided conclusive data on the safety or clinical efficacy of ESP treatment. The aim of this study was to explore the safety and therapeutic effects of ESPs in patients with anemia and CHF. A systematic literature search in EMBASE and MEDLINE from their inception to July 2013 was performed, and clinical studies that evaluated the effects of ESPs among patients with CHF were identified. Randomized clinical trials comparing the effects of ESP treatment with those of placebo treatment or usual care regimes in anemic patients with CHF were included. Nine randomized, controlled trials were identified, comprising 750 patients with CHF and anemia receiving ESP treatment for between three months and one year. ESP treatment had a significantly lower risk of CHF hospitalization [relative risk (RR), 0.47; 95% confidence interval (CI), 0.32–0.70; P=0.0002] and a moderate reduction in mortality risk (RR, 0.68; 95% CI, 0.38–1.19; P=0.18). Treatment with ESPs in patients with symptomatic CHF and anemia resulted in significant improvements in hemoglobin, hematocrit and brain natriuretic peptide levels, as well as exercise capacity, renal function, New York Heart Association class and left ventricular ejection fraction. In conclusion, this study found that treatment with ESPs exerts beneficial effects against CHF and is not associated with a higher mortality rate or adverse effects. These outcomes support the instigation of a trial evaluating the treatment of anemia with ESPs in patients with chronic CHF.

Effectiveness of erythropoietin supplementation against chronic heart failure with anemia, and its effect on serum hypersensitive C reaction protein, homocysteic acid and Btype natriuretic peptide

“…Anemia accelerates the heartbeat of CHF patients and increases their myocardial oxygen consumption, thereby aggravating work load of the heart, which then decreases cardiac function gradually [17]. A meta-analysis of 9 randomized controlled trials in which 750 patients with CHF and anemia received ESP therapies for 3-12 months showed that hospitalization risk, death rate and the adverse events were significantly decreased [18]. In a study in which 73 elderly patients with heart failure and anemia were randomly divided into control group given conventional anti-heart failure therapies, and experimental group given oral iron supplement agents, EPO subcutaneous injection as well as conventional anti-heart failure therapies, the results showed that when compared with the control group, cardiac function indices were markedly improved and the incidence of cardiovascular adverse events were significantly decreased in the experimental group [19].…”

A retrospective analysis of 1,231 patients with anemia after surgical treatment of hyperthyroidism

“…Anemia: All patients showed a reduction in hemoglobin (Hb) concentration on the day of surgery, anemia was diagnosed at Hb levels below 120 g/l for male, below <110 g/l for female, and below <110 g/l for pregnant women ( 9 , 10 ). Moderate anemia: Hb 60–90 g/l, severe anemia: Hb 60–31 g/l, and severe anemia: Hb ≤30 g/l.…”