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Abstract
• This work has been carried out to find the prevalence of anemia and CKD in patients with heart failure.
• We aimed to find correlation between degree of heart Failure (expressed by NYHA class) and both degree of anemia (expressed by Hb and Ht. ) and degree of CKD (expressed by GFR, microalbuminurea , serum creatinine, blood urea ).
• Our study was conducted on 80 patients with heart failure from internal medicine department ,cardiology department in Banha university hospital.
In our study we found that:
• Aging of the population and prolongation of the lives of cardiac patients by modern therapeutic innovations has led to an increasing prevalence of heart failure (HF).
• Despite advances in medical treatment, the prognosis for patients with chronic heart failure (HF) remains poor.
• There was significant difference between anemic and non anemic group in: GFR, CKD stage, serum creatinine , blood urea , microalbuminurea, EDD , ESD and EF%.
• There was significant difference between microalbuminuric and non microalbuminuric group in: Hb and Ht.
• There was significant difference between CRI and non CRI group in: Hb, Ht. and EF%.
• There was significant difference between NYHA class I and NYHA class IV group in: Hb, Ht, GFR, CKD stage, serum creatinine , blood urea, microalbuminurea and EF%.
• There was significant difference between systolic LV dysfunction and preserved systolic function group in : age , Hb, Ht, GFR, CKD stage and serum creatinine.
• There were significant negative correlation between Degree of heart failure (expressed by NYHA classes) and Hb, Ht., EF% and GFR.
• There were significant positive correlation between Degree of heart failure (expressed by NYHA classes) and serum creatinine , blood urea microalbuminurea, And LV Mass.
So we conclude that:
• The final evidence about the value of correction of the anemia of CHF with EPO and iron is not yet in. However the epidemiological studies in CHF overwhelmingly attest to the strong association between anemia and increased mortality, increased hospitalizations, increased severity of CHF and reduced Quality of Life in those who are anemic.
• The present clinical evidence on the correction of the anemia on CHF with EPO and oral or IV iron also suggests that this treatment may improve many aspects of CHF including cardiac function, renal function, hospitalizations, exercise capacity and Quality of Life.
• In CHF patients who are being maximally treated with all the recommended CHF medications in the recommended doses but who are still not doing well and who have Hb levels below 12 g/dl, physicians should at least be aware that this form of therapy is available, appears to be safe, and in the interventional studies currently available, appears highly effective in improving CHF.
Recommendation:
• Cooperation must exist between cardiologists,and nephrologists in treating these anemic CHF patients’ since the vast majority of these patients will also have moderate to severe renal insufficiency.
• If CHF is an important factor in the progression of CKI and anaemia, it would mean that early detection and treatment of cardiac damage and CHF would not only cause an improvement in cardiac function and CHF, but would also improve the anaemia and CKI. It also means that treating CHF without treating the associated anaemia will not stop the progression of CHF or CKI. This, indeed, has been our experience. Similarly, treating the anaemia without providing optimal medical therapy for CHF would also not be effective.