[Cardio-renal syndrome and anaemia]

Abstract

Cardiorenal syndrome (CRS) presents concomitant heart and kidney failure. Chronic heart failure (CHF) and chronic kidney failure (CKF) prevail in the majority of the cases, although by definition both the acute and the chronic dysfunction of either organ can be the cause. Anemia is thus the consequence of the both organ systems' failures. At the same time, anemia tends to worsen the failures of the both organ systems themselves. Each decrement of the hemoglobin blood concentration for 10 g/L increase overall mortality rate in this population for 20%. CRS with anemia forms a spellbound triangle called cardiorenal-anemia syndrome (CRAS). Mutual associations between the three compounds of the syndrome are subjects of numerous studies. The question arises weather anemia the point of convergence or divergence for CHF and CKD. Actually, anemia correction by erythropoietin does not achieve same effect in patients with CHF as in those with CKD. It becomes clearer that erythropoietin does not have only hematopoetic effects and that erythropoietin treatment does not mean only anemia correction. Erythropoietin plays the major role in treating anemia, but it is not a solo play. The leading feature by that treatment is the renal compound of the syndrome. Target hemoglobin values have then adjusted according to the renal compound of the syndrome, although it is not sureif those values are still convenient for a patient having concomitant CHF. Patients with CHF and anemia without apparent CKF do not even need erythropoietin. Although CKF often follows CHF and vice versa, and despite the fact that the failure of the both organ systems is frequently accompanied by anemia, there is an important proportion of CHF patients with normal kidney function and also not small number of CKF patients with normal cardiac function. Nevertheles, there is a significant percentage of patients with CHF and/or CKF without anemia. The paper presents a review of the published data related to the CRAS with a special attention devoted to anemia, usually a successfully treatable component of the syndrome.