Abstract
Anemia is common in patients with chronic heart failure (CHF), and an independent predictor of poor prognosis. Renal dysfunction, chronic inflammation, hemodilution, bone marrow dysfunction, and iron deficiency might contribute to the development of anemia. Many clinical trials have examined the effects of erythropoiesis-stimulating agents (ESAs) on the clinical symptoms, exercise tolerance, and prognosis of CHF patients. Several small-scale trials showed the favorable effects of ESAs. However, the largest clinical trial STAMINA-HeFT (n=319) failed to show a beneficial effect of darbepoetin α on the clinical symptoms of CHF patients. On the other hand, the importance of iron deficiency has lately attracted considerable attention as a cause of not only anemia but also exercise intolerance. We have shown that the expression of duodenal iron transporters is impaired in heart failure model rats. The largest clinical trial of intravenous iron supplementation FAIR-HF (n=459) showed improvement of clinical symptoms and exercise tolerance in CHF patients with or without anemia. Further understanding of the pathophysiology of anemia seems to be necessary for the treatment of anemia in CHF patients. (Jpn J Clin Pharmacol Ther 2012; 43(5): 323-330)
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