Limits...
Anemia associated with chronic heart failure: current concepts.

Shah R, Agarwal AK - Clin Interv Aging (2013)

Bottom Line: Anemia is a frequent comorbidity of heart failure and is associated with poor outcomes.Anemia in heart failure is considered to develop due to a complex interaction of iron deficiency, kidney disease, and cytokine production, although micronutrient insufficiency and blood loss may contribute.Treatment with erythropoietin-stimulating agents has been considered alone or in combination with iron, but robust evidence to dictate clear guidelines is not currently available.

View Article: PubMed Central - PubMed

Affiliation: Division of Nephrology, The Ohio State University, Columbus, Ohio 43210, USA. anil.agarwal@osumc.edu

ABSTRACT
Anemia is a frequent comorbidity of heart failure and is associated with poor outcomes. Anemia in heart failure is considered to develop due to a complex interaction of iron deficiency, kidney disease, and cytokine production, although micronutrient insufficiency and blood loss may contribute. Currently, treatment of anemia of heart failure lacks clear targets and specific therapy is not defined. Intravenous iron use has been shown to benefit anemic as well as nonanemic patients with heart failure. Treatment with erythropoietin-stimulating agents has been considered alone or in combination with iron, but robust evidence to dictate clear guidelines is not currently available. Available and emerging new agents in the treatment of anemia of heart failure will need to be tested in randomized, controlled studies.

Show MeSH

Related in: MedlinePlus

Overlapping mechanisms of anemia in heart failure.© Hindawi Publishing Corporation. Adapted with permission from Alexandrakis MG, Tsirakis G. International Scholarly Research Network. Hematology. 2012.30Abbreviations: EPO, epoetin; IL-6, interleukin-6; RAAS, renin-angiotensin-aldosterone system; TNF-á, tumor necrosis alpha.
© Copyright Policy
Related In: Results  -  Collection


getmorefigures.php?uid=PMC3569049&req=5

f1-cia-8-111: Overlapping mechanisms of anemia in heart failure.© Hindawi Publishing Corporation. Adapted with permission from Alexandrakis MG, Tsirakis G. International Scholarly Research Network. Hematology. 2012.30Abbreviations: EPO, epoetin; IL-6, interleukin-6; RAAS, renin-angiotensin-aldosterone system; TNF-á, tumor necrosis alpha.

Mentions: Treatment with angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers inhibits erythropoiesis, as evidenced by a decrease in hemoglobin concentration up to 0.3 g/dL.27 This is mainly due to antagonism of a decrease in angiotensin II-medicated renal hypoxia which in turn triggers erythropoietin production. Notably, angiotensin II also stimulates production of erythropoietic cells directly by the bone marrow.21 In addition, the amino terminal catalytic domain of the ACE degrades the hematopoiesis inhibitor, N-acetyl-seryl-aspartyl-lysyl-proline (Ac-SDKP). Elevated levels of Ac-SDKP result in inhibition of hematopoiesis and lead to a fall in hemoglobin concentration in HF patients with on ACE inhibitor therapy.28 However, experimental data in various knockout mouse models involving different angiotensin-converting enzyme components fail to support this theory.29Figure 1 illustrates the complex inter-relationships of all these mechanisms in the setting of heart failure.30


Anemia associated with chronic heart failure: current concepts.

Shah R, Agarwal AK - Clin Interv Aging (2013)

Overlapping mechanisms of anemia in heart failure.© Hindawi Publishing Corporation. Adapted with permission from Alexandrakis MG, Tsirakis G. International Scholarly Research Network. Hematology. 2012.30Abbreviations: EPO, epoetin; IL-6, interleukin-6; RAAS, renin-angiotensin-aldosterone system; TNF-á, tumor necrosis alpha.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3569049&req=5

f1-cia-8-111: Overlapping mechanisms of anemia in heart failure.© Hindawi Publishing Corporation. Adapted with permission from Alexandrakis MG, Tsirakis G. International Scholarly Research Network. Hematology. 2012.30Abbreviations: EPO, epoetin; IL-6, interleukin-6; RAAS, renin-angiotensin-aldosterone system; TNF-á, tumor necrosis alpha.
Mentions: Treatment with angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers inhibits erythropoiesis, as evidenced by a decrease in hemoglobin concentration up to 0.3 g/dL.27 This is mainly due to antagonism of a decrease in angiotensin II-medicated renal hypoxia which in turn triggers erythropoietin production. Notably, angiotensin II also stimulates production of erythropoietic cells directly by the bone marrow.21 In addition, the amino terminal catalytic domain of the ACE degrades the hematopoiesis inhibitor, N-acetyl-seryl-aspartyl-lysyl-proline (Ac-SDKP). Elevated levels of Ac-SDKP result in inhibition of hematopoiesis and lead to a fall in hemoglobin concentration in HF patients with on ACE inhibitor therapy.28 However, experimental data in various knockout mouse models involving different angiotensin-converting enzyme components fail to support this theory.29Figure 1 illustrates the complex inter-relationships of all these mechanisms in the setting of heart failure.30

Bottom Line: Anemia is a frequent comorbidity of heart failure and is associated with poor outcomes.Anemia in heart failure is considered to develop due to a complex interaction of iron deficiency, kidney disease, and cytokine production, although micronutrient insufficiency and blood loss may contribute.Treatment with erythropoietin-stimulating agents has been considered alone or in combination with iron, but robust evidence to dictate clear guidelines is not currently available.

View Article: PubMed Central - PubMed

Affiliation: Division of Nephrology, The Ohio State University, Columbus, Ohio 43210, USA. anil.agarwal@osumc.edu

ABSTRACT
Anemia is a frequent comorbidity of heart failure and is associated with poor outcomes. Anemia in heart failure is considered to develop due to a complex interaction of iron deficiency, kidney disease, and cytokine production, although micronutrient insufficiency and blood loss may contribute. Currently, treatment of anemia of heart failure lacks clear targets and specific therapy is not defined. Intravenous iron use has been shown to benefit anemic as well as nonanemic patients with heart failure. Treatment with erythropoietin-stimulating agents has been considered alone or in combination with iron, but robust evidence to dictate clear guidelines is not currently available. Available and emerging new agents in the treatment of anemia of heart failure will need to be tested in randomized, controlled studies.

Show MeSH
Related in: MedlinePlus