The importance of correction of anemia with erythropoietin and intravenous iron in severe resistant congestive heart failure

Wexler, Dov; Silverberg, Don; Sheps, David; Iaina, Adrian
June 2003
European Journal of Heart Failure. Supplements;Jun2003, Vol. 2 Issue 2, p225
Academic Journal
About one third to one half of patients with heart failure are anemic, in that they have a hemoglobin level of less than 12 g/dL. Anemia is more common and more severe as the clinical status of CHF worsens. In addition, anemia is associated with a higher mortality and higher rate of hospitalization, as well as with signs of malnutrition. In anemic CHF patients who are resistant to maximally tolerated CHF medications and who remain very symptomatic, both uncontrolled studies of a combination of subcutaneous erythropoietin (EPO) and IV ferric sucrose have reported a correction of the anemia. This correction has been associated with an improvement in NYHA functional status, left ventricular ejection fraction, and a marked reduction in the doses of diuretic needed and in the frequency and duration of hospitalizations. Renal function, which had been steadily falling before the correction of the anemia, was also stabilized. Other controlled studies have also found that anemia correction with EPO increased oxygen utilization during maximal exercise, exercise endurance and quality to life. The anemia is probably due mainly to a combination of renal failure and excessive cytokines, both of which interfere with EPO production and utilization. If confirmed by larger studies, correction of anemia with the EPO-IV iron combination may become a useful adjuvant to the treatment of CHF.


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