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Renal Dysfunction and Anemia in Patients with Heart Failure - The Cardio-renal Anemia Syndrome

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Dr Abhay Sadre, Pune    12 January 2018

  1. Renal impairment frequently occurs in heart failure patients, and negatively affects the quality-of-life and life expectancy of these patients. The “Cardio-renal anemia syndrome” (CRAS) is referred to a condition when all the three conditions; renal impairment, anemia and heart failure coexist.
  2. In spite of generally defined CRAS, there are currently no guidelines available for its diagnosis and management.
  3. Anemia in CRAS is generally treated as per the guidelines for the treatment of anemia.
  4. Intravenous iron therapy is recommended in patients of CRAS owing to its favorable effect on the cardiac and renal function, improvement in the tolerance of effort, NYHA functional call and increase in the left ventricular ejection fraction.
  5. FAIR-HF study was conducted to determine the effects of IV ferric carboxymaltose used in the treatment of symptomatic patients with HF and iron deficiency. Almost 40% patients in the study had a significant renal dysfunction (eGFR <60 mL/min/1.73 m2 of the body surface). A significant improvement of HF symptoms, increased tolerance of effort and better life quality was observed in the study population. The IV ferric carboxymaltose therapy was not only beneficial in anemic patients, but also in patients with HF and iron deficiency without anemia.
  6. The current treatment is largely dependent on the specialization of the physician, the patient first refers to; cardiologist prioritizes HF treatment while nephrologists focus on nephron protection and renal dysfunction.
  7. It is imperative that in absence of specific guidelines for the diagnosis and management of CRAS, a multidisciplinary team of physicians treats the patients of the CRAS relying their treatment strategy on existing guidelines for specific components of the syndrome.

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