Anaemia in chronic heart failure is not only related to impaired renal perfusion and blunted erythropoietin production, but to fluid retention as well

• Published in: European heart journal 2007-01, Vol.28 (2), p.166-171
• Main Authors: Westenbrink, B. Daan, Visser, Folkert W., Voors, Adriaan A., Smilde, Tom D.J., Lipsic, Erik, Navis, Gerjan, Hillege, Hans L., van Gilst, Wiek H., van Veldhuisen, Dirk J.
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Anemia - etiology; Anemias. Hemoglobinopathies; Biological and medical sciences; Cardiology. Vascular system; Cell Size; Chronic Disease; Diseases of red blood cells; Erythropoietin - metabolism; Female; Heart; Heart Failure - complications; Heart Failure - metabolism; Heart failure, cardiogenic pulmonary edema, cardiac enlargement; Hematologic and hematopoietic diseases; Hemoglobins - metabolism; Humans; Kidney Diseases - complications; Kidney Diseases - metabolism; Male; Medical sciences; Middle Aged; Renal Circulation - physiology; Renal Plasma Flow, Effective - physiology; Water-Electrolyte Imbalance - complications
• ISSN: 0195-668X; 1522-9645
• DOI: 10.1093/eurheartj/ehl419

Aims Anaemia is prevalent in the chronic heart failure (CHF) population, but its cause is often unknown. The present study aims to investigate the relation between anaemia, renal perfusion, erythropoietin production, and fluid retention in CHF patients. Methods and results We studied 97 patients with CHF, of which 15 had anaemia (Hb < 13.0 g/dL in men and Hb < 12.0 g/dL in women), without haematinic deficiencies. Glomerular filtration rate (GFR) and extracellular volume (ECV) were measured as the clearance and the distribution volume of constantly infused 125I-iothalamate, respectively. Effective renal plasma flow (ERPF) was determined as the clearance of 131I-hippuran. Anaemic CHF patients displayed significantly reduced GFR (P = 0.002), ERPF (P = 0.005) and EPO production (P = 0.001), and an elevated ECV (P = 0.015). Multivariable analysis demonstrated that lower GFR (P = 0.003), lower ERPF (P = 0.004), lower EPO production (P = 0.006), and a higher ECV (P = 0.001) were significant independent predictors of lower haemoglobin levels. Conclusion Anaemia in CHF is not only independently associated with impaired renal perfusion and blunted EPO production, but to fluid retention as well.