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Anemia: The Point of Convergence or Divergence for Kidney Disease and Heart Failure?
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| 09.03.2009, 15:57 |
Cardiorenal anemia syndrome refers to the simultaneous presence of anemia, heart failure (HF), and chronic
kidney disease (CKD) that forms a pathologic triangle with an adverse impact on morbidity and mortality. The
reciprocal relationships among these 3 components have been the subject of a number of trials with inconsistent
and sometimes paradoxic results. In this paper, the pathophysiologic concepts underlying interactions
among these 3 conditions are discussed. Then, the similarities and dissimilarities of the relationships between
anemia and either HF or CKD are considered; explanations are provided for differences in the results of the currently
available studies. Erythropoietin-stimulating agent protocols are usually based on the results of studies
designed for the CKD population, and upper hemoglobin target levels are chosen to avoid cardiovascular complications.
It is not yet clear whether those renal guidelines are optimal for patients with HF, especially because
those patients may have reversible components of kidney dysfunction, both HF and renal parameters improving
with anemia correction. We review these issues and suggest a pragmatic approach to the care of patients with
HF until such time that controlled trials establish definitive anemia treatment goals that are dynamic and disease
specific, rather than those that adopt a more simplistic hemoglobin-specific approach. (J Am Coll Cardiol
2009;53:639–47) © 2009 by the American College of Cardiology Foundation
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| Категория: Статьи | Добавил: nbylova
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