Cardiorenal Anemia Syndrome Research Articles

Role of selenium in the pathophysiology of cardiorenal anaemia syndrome.

Chronic kidney disease (CKD) and cardiovascular disease (CVD) have multiple bidirectional mechanisms, and anaemia is one of the critical factors that are associated with the progression of the two disorders [referred to as cardiorenal anaemia syndrome (CRAS)]. Several lines of evidence indicate that CRAS confers a worse prognosis, suggesting the need to clarify the underlying pathophysiology. Among the micronutrients (trace elements) that are essential to humans, inadequate iron status has previously been implicated in the pathogenesis of CRAS; however, the roles of other trace elements remain unclear. Selenium critically regulates the function of selenoproteins, in which selenocysteine is present at the active centres. The human genome encodes 25 selenoproteins, and accumulating data indicate that they regulate diverse physiological processes, including cellular redox homeostasis, calcium flux, thyroid hormone activity and haematopoiesis, all of which directly or indirectly influence cardiac function. The essential role of selenium in human health is underscored by the fact that its deficiency results in multiple disorders, among which are cardiomyopathy and abnormal erythrocyte morphology. Studies have shown that selenium deficiency is not uncommon in CKD patients with poor nutritional status, suggesting that it may be an under-recognized cause of anaemia and cardiovascular disorders in these patients. In this review, we discuss the role of selenium in the pathophysiology of CKD, particularly in the context of the interconnection among CKD, cardiac dysfunction and anaemia. Given that selenium deficiency is associated with treatment-resistant anaemia and an increased risk of CVD, its role as a key modulator of CRAS merits future investigation.

Impact of Cardiorenal Anaemia Syndrome on Clinical Features in Elderly Outpatients with Chronic Heart Failure: A Japanese Community Hospital Experience

Background: Cardiorenal anaemia syndrome (CRAS) has been reported to be associated with all-cause mortality and cardiovascular events in outpatients with heart failure (HF). Objective: To evaluate the clinical situation of CRAS including NYHA class and care status in elderly outpatients with HF. Methods: A total of 41 elderly (>65 years) outpatients with HF attending our hospital were analysed retrospectively and cross-sectionally. Clinical variables included lifestyle diseases, atrial fibrillation, valvular heart disease, HFpEF, chronic kidney disease (CKD), cardiac function (LVEF, E/e’, LADI, BNP), anaemia (Hb, Fe/TIBC (%), ferritin), medications (diuretics, MRA, ACEI/ARB, β-blockers, SGLT2i, ARNI, tolvaptan), NYHA class (I/II/III/IV). The nursing variables analysed were Japanese nursing certification class, which assesses active daily living (ADL), instrumental ADL, cognitive function, mental function, physical function, communication, and need for support/care (from least to most intensive, independence 0/support(S)1/S2/care(C)1/C2/C3/C4/C5) and frailty. Subjects were divided into two groups (CRAS+group and CRAS−group) according to the presence of CRAS, defined as HF associated with CKD (eGFR < 60 mL/min/1.73 m2) and anaemia (Hb < 13 g/dL, men and Hb < 12 g/dL, women). All variables were compared between the two groups. Results: Mean age was 83.7 ± 7.1 years (67∼100). Female gender was 63.4% (26/41). The incidence of HFpEF was 33/41 (80.5%). The incidence of CRAS was 53.7% (22/41). The incidence of lifestyle diseases was not different between the two groups. Cardiac function was not significantly different between the two groups (CRAS+ vs. CRAS−): LVEF (59.1 ± 8.3 vs. 61.3 ± 7.2); E/e (15.1 ± 5.8 vs. 15.0 ± 7.0); LAVI (50.6 ± 16.6 vs. 54.3 ± 30.9); BNP (347.0 ± 234.4 vs. 291.3 ± 197.0). Hb was significantly lower in the CRAS+ group than in the CRAS group (10.4 ± 1.4 vs. 13.4 ± 1.7, P < 0.0001). Fe/TIBC and ferritin were not significantly different between the two groups. Regarding medications, tolvaptan tended to be used more frequently in the CRAS+ group than in the CRSA− group (4/22 vs. 0/18, P = 0.111). The other drugs were used with similar frequency. Meanwhile, the NYHA class tended to be higher in the CRAS+ group than in the CRAS− group: NYHA (8/9/5/0 vs. 8/11/0/0, P = 0.082). Nursing class showed more intensive care in the CRAS+ group than in the CRAS−group (4/3/3/2/4/1/3/2 vs. 11/0/6/1/0/1/0/0, P = 0.021). Conclusions: The association of CRAS with HF was associated with more intensive support/care status but not with cardiac function/BNP and other factors. Prevention and active treatment of CRAS may improve the independence of elderly outpatients with HF.

Prevalence, clinical correlates and outcomes of cardiorenal anemia syndrome among patients with heart failure attending tertiary referral hospital in Dodoma, Tanzania: A protocol of a prospective observational study.

Cardiorenal anemia syndrome (CRAS) is a common complication among patients with heart failure and is associated with poor clinical outcomes. However, there is a paucity of published data concerning CRAS, despite of significant increase in heart failure patients attending medical services in developing countries. This study aims to assess the prevalence, clinical correlates, and outcomes of CRAS among patients with heart failure attending the Benjamin Mkapa Hospital in Dodoma, Tanzania. A prospective observational study is ongoing at the Benjamin Mkapa Hospital in Dodoma, Tanzania. Currently, 92 patients have been recruited into this study and process is not yet completed. The socio-demographic data, clinical correlates, and prevalence of CRAS will be determined at baseline meanwhile, the outcomes of CRAS will be determined during a follow-up period of six months from the date of enrollment. CRAS is the primary outcome of the study. Data will be categorized into CRAS and non-CRAS during statistical analysis. Mean and standard deviation will be used for normally distributed continuous variables while median and interquartile range will be used for skewed data. Frequencies and percentages will summarize categorical variables. Clinical correlates and outcomes of CRAS will be analyzed and compared by using univariate and multivariate logistic regression and Cox proportional hazards models. A two-tailed p-value of less than 0.05 will indicate statistical significance.

The prognostic impact of cardio-renal anaemia syndrome in Japanese acute decompensated heart failure patients stratified by left ventricular ejection fraction

Abstract Background Cardio-renal anaemia syndrome (CRAS) has been reported to be an important prognostic factor for events in heart failure (HF) patients. Previous reports have shown that it has relatively little prognostic impact in patients with preserved left ventricular ejection fraction (LVEF), which remains controversial. We therefore investigated the prognostic impact of CRAS in Japanese acute decompensated heart failure (ADHF) patients according to LVEF. Methods We combined two registry studies of ADHF patients in Japan and examined HF events and their associated factors over a 2-year observation period. The prognostic impact of CRAS was also analysed by LVEF. The primary endpoint was defined as all-cause mortality or HF hospitalisation. Renal dysfunction was defined as eGFR <60 mL/min/1.73 m2 and anaemia as haemoglobin <13 g/dl in men and <12g/dl in women. CRAS was defined as the presence of both renal dysfunction and anaemia. Three groups were also created by LVEF (>50%, 40-49% and <40%) and analysed separately. Results A total of 2142 patients were enrolled. Mean age was 78.7 years and 49% of the patients was male. Previous coronary artery disease and atrial fibrillation were present in 31% and 44% of the patients, respectively. Medications included beta-blockers in 61% and renin-angiotensin system inhibitors in 53% of the patients. Renal dysfunction was present in 1676 (74%) and anaemia was seen in 1523 (67%) patients. CRAS was present in 1190 (53%) patients. During the mean follow-up period of 623±244 days, the primary endpoint was observed in 1015 patients, with 563 deaths and 737 HF hospitalisations. Multivariate analysis in a Cox proportional hazards model showed that CRAS was an independent prognostic factor in all patients (hazard ratio [HR]1.488;95% confidence interval [CI] 1.292-1.715, p<0.001). Multivariate analysis was also performed in three groups of patients with LVEF >50%, 40-49% and <40%. As with all patients, CRAS was an independent predictor of the primary endpoint in the three groups. (LVEF >50% [1273 patients]: HR1.313[95%CI 1.089-1.583], p = 0.004; LVEF 40-49% [381 patients]:HR,1.907[95%CI 1.323-2.750], p<0.001; LVEF <40% [651 patients]:HR: 1.446[95%CI 1.117-1.872]; p = 0.005) Conclusion In the present registry study of Japanese patients with ADHF, CRAS was a important prognostic factor. The results also confirmed a similar trend in patients with any LVEF.

Dimethyl Fumarate Ameliorated Cardiorenal Anemia Syndrome and Improved Overall Survival in Dahl/Salt-Sensitive Rats.

Cardiovascular disease, chronic kidney disease, and anemia are known to adversely affect each other. Inflammation is commonly involved in these diseases. Cardiorenal anemia syndrome (CRAS) is the name given to this mutually harmful condition. Dimethyl fumarate (DMF) is a Food and Drug Administration-approved antioxidant and anti-inflammatory agent. The purpose of this study was to investigate the effects of DMF on Dahl/salt-sensitive (DS) rats as a CRAS model. Six-week-old DS rats were divided into three groups: the control group, the high-salt (HS) group, and the HS+DMF group. The HS and HS+DMF groups were fed a high-salt diet (8% NaCl) from 6 weeks of age. In the HS+DMF group, DMF (90 mg/kg per day) was orally administered from 6 to 15 weeks of age. Systolic blood pressure was measured every 2 weeks. The heart and renal injuries were assessed with histopathological analysis. The heart and renal expression of mRNAs was assessed by reverse-transcription polymerase chain reaction. DMF significantly improved overall survival, which was shortened by HS in DS rats. Systolic blood pressure increased in the HS group compared with the control group, and DMF tended to suppress this change. DMF ameliorated the cardiac and renal abnormalities confirmed in the HS group by histopathological analysis. Furthermore, the changes in mRNA expressions associated with disease exacerbation in the HS group were suppressed by DMF. DMF also improved anemia. This study suggests that DMF improves overall survival in DS rats through organ-protective effects and is effective against cardiorenal anemia syndrome. SIGNIFICANCE STATEMENT: Dimethyl fumarate was found to improve overall survival in Dahl/salt-sensitive rats, associated with its ability to ameliorate anemia and induce cardioprotective and renoprotective effects through anti-inflammatory and antifibrotic effects.

The prevalence of cardiorenal anemia syndrome among patients with heart failure and its association with all-cause hospitalizations: a retrospective single-center study from the Middle East.

Little is known about the burden of cardiorenal syndrome (CRS) and cardiorenal anemia syndrome (CRAS) in the Middle East Region. Furthermore, whether the occurrence rates of CRAS differ across heart failure (HF) phenotypes is not widely investigated. We aimed to examine the prevalence of CRS and CRAS in patients with HF, compare characteristics of patients with CRAS-HFrEF vs. CRAS-HFpEF, and investigate anemia association with 1-year all-cause hospitalizations. HF patients who visited a multidisciplinary HF clinic at a single center between 10-2015 and 06-2022 (n = 968) were retrospectively included. Differences in rates of CRAS prevalence, and patients' characteristics of those with CRAS-HFrEF vs. CRAS-HFpEF were determined using appropriate testing methods. Generalized estimating equation (GEE) models were used to determine if anemia was associated with higher rates of hospitalization. CRS was prevalent in 34.4% of subjects, while 25.3% had CRAS. CRAS prevalence rates among patients with HFpEF vs. HFrEF were comparable (27.2% vs. 24.2%, p = 0.3). Compared to patients with HFrEF-CRAS, those with HFpEF-CRAS were more likely females (p < 0.001), had a higher burden of hypertension (p = 0.01), and lower hemoglobin (p = 0.02). In an adjusted GEE model, anemia was associated with an average increase of 1.8 admissions in CRS patients (p = 0.015). In patients with HF, 1 in 3 patients presented with CRS, and 1 in 4 patients had CRAS. The prevalence of CRAS was comparable among those HFpEF and HFrEF. Anemia was associated with an increased rate of 1-year all-cause hospitalization in CRS patients.

Fluctuation of Heart Failure with Preserved Ejection Fraction During the Course of Cardiorenal Anemia Syndrome: A Case Report

Heart failure (HF) with preserved ejection function (HFpEF) has a high prevalence in older adults. HF in the elderly tends to be complicated by renal failure and anemia, known as cardio-renal anemia syndrome (CRAS), with each pathology adversely affecting the other, leading to a negative spiral. The temporal evolution from the onset of HFpEF in CRAS is not well understood. We experienced an elderly case in which the initial onset of CRAS was followed by repeated exacerbations with HFpEF. Multiple medications, including a sodium-glucose cotransporter-2 inhibitor and an angiotensin receptor neprilysin inhibitor, were effective in conjunction with extensive cardiac rehabilitation. Our case highlights the difficulty of treating HFpEF with CRAS.

Managing Anemia: Point of Convergence for Heart Failure and Chronic Kidney Disease?

The pathologic triangle formed by chronic heart failure (HF), chronic kidney disease (CKD), and anemia carries high morbidity and mortality rates and decreases quality of life. Anemia represents a common condition in patients with advanced HF and CKD, with a total prevalence in cardiorenal syndrome (CRS) ranging from 5% to 55%. Searching for a pragmatic approach for these patients with guided and disease-specific recommendations beyond just targeted hemoglobin therapeutic behavior represents the core of research for ongoing clinical trials. It is well known that the prevalence of anemia increases with the advancement of CKD and HF. The physiopathological mechanisms of anemia, such as the reduction of endogenous erythropoietin and the decrease in oxygen transport, are leading to tissue hypoxia, peripheral vasodilation, stimulating neurohormonal activity, and maintenance of the progressive renal and cardiac dysfunction. Given the challenges with the treatment options for patients with cardiorenal anemia syndrome (CRSA), new therapeutic agents such as hypoxia-inducible factor-prolyl hydroxylase domain inhibitors (HIF-PH) or hepcidin antagonists are emerging in the light of recent research. This review summarizes the potential therapeutic tools for anemia therapy in the cardiorenal population.

Role of Iron Deficiency in Heart Failure-Clinical and Treatment Approach: An Overview.

The association of chronic heart failure (CHF) and iron deficiency (ID) with or without anemia is frequently encountered in current medical practice and has a negative prognostic impact, worsening patients' exercise capacity and increasing hospitalization costs. Moreover, anemia is common in patients with chronic kidney disease (CKD) and CHF, an association known as cardio-renal anemia syndrome (CRAS) possessing a significantly increased risk of death. This review aims to provide an illustrative survey on the impact of ID in CHF patients-based on physiopathological traits, clinical features, and the correlation between functional and absolute ID with CHF-and the benefit of iron supplementation in CHF. We selected the most recent publications with important scientific content covering the association of CHF and ID with or without anemia. An intricate physiopathological interplay is described in these patients-decrease in erythropoietin levels, activation of the renin-angiotensin-aldosterone system, systemic inflammation, and increases in hepcidin levels. These mechanisms amplify anemia, CHF, and CKD severity and worsen patients' outcomes. Anemia is frequently encountered in CHF and represents a negative prognostic factor. Data from randomized controlled trials have underlined the administration of intravenous iron therapy (ferric carboxymaltose) as the only viable treatment option, with beneficial effects on quality of life and exercise capacity in patients with ID and systolic heart failure.

Cardiovascular Protective Effects of Oral Hypoxia Inducible Factor Prolyl Hydroxylase Inhibitor Roxadustat in the Treatment of Type 4 Cardiorenal-Anemia Syndrome: Protocol of a Randomized Controlled Trial.

BackgroundPatients with chronic kidney disease (CKD) are at high risk of developing heart failure and anemia, which is defined as type 4 cardiorenal-anemia syndrome (CRAS). CRAS aggravates the deterioration of both kidney and heart function, ultimately resulting in a high mortality. This study aims to examine the efficacy and safety of roxadustat in the treatment of type 4 CRAS.Methods and DesignThis study is designed as a randomized, open-label, controlled trial. A total of 68 patients diagnosed with type 4 CRAS will be randomly divided into roxadustat group and erythropoietin with a 1:1 ratio. Participants in the roxadustat group will receive roxadustat with an initial dose of 70 or 100 mg three times a week, and participants in the erythropoietin group will receive subcutaneous injection of erythropoietin for 24 weeks, to maintain a hemoglobin ranging from 100 to 120 g per liter. The primary outcome is the change in heart function, including brain natriuretic peptide (BNP), 6-min walk test (6-WT), and left ventricular ejection fraction (LVEF). Secondary outcomes to be assessed include death, cardiovascular events, hospitalization regarding heart failure, Minnesota Heart Failure Quality of life scale (MLHFQ) score, New York Heart Association (NYHA) cardiac function grade, echocardiographic parameters including left ventricular diastolic diameter and volume (LVDD and LVDV) and ventricular mass (LVM), anemia related parameters, inflammatory parameters, and safety assessments.ConclusionThe findings of this study will provide potential evidence for roxadustat in CRAS management.Trial RegistrationChinese Clinical Trial Registry, ID: ChiCTR2100050031. Registered on 16 August 2021.

M2. Cardiorenal anaemia syndrome vs left ventricular ejection fraction: which is a better mortality prognostic factor for heart failure? A systematic review and meta-analysis

Abstract Aim Cardiorenal anaemia syndrome (CRAS) involves a vicious interaction between heart failure (HF), chronic kidney disease, and anaemia. CRAS is associated with higher morbidity, mortality, and health care cost. This study investigated CRAS as a predicting factor of all-cause mortality compared to left ventricular ejection fraction (LVEF) in HF patients as one of the established classifications being linked to prognosis in HF. Methods and Results A systematic review based on PRISMA guidelines was performed on 6 scientific databases (PubMed, ProQuest, Scopus, ScienceDirect, Springer) with search terms related to left ventricular ejection fraction, heart failure, and cardiorenal anaemia syndrome. Original English case-control and cohort studies in heart failure participants which analyzed hazard ratio (HR) of all-cause mortality were considered eligible. The quality assessment was evaluated with New Castle Ottawa Scale (NOS). A total of 17 studies comprising 90,092 participants from more than 14 countries were included in the qualitative analysis with eleven subjected to meta-analysis. The presence of CRAS aligns with a significantly higher mortality rate (HR 1.64 [95% CI 1.44 – 1.87]) as compared to current classification based on ejection fraction obtained insignificant clinical outcomes of reduced ejection fraction HF (HFrEF) (HR 1.06 [95% CI 0.98 – 1.15]) in the pooled analysis. Conclusion CRAS is a significant death prognosticator and indicates a worse prognosis in HF patients as compared to HF patients with reduced ejection fraction. CRAS is a potential alternative prognostic factor for heart failure patients to predict mortality outcomes.

Anemia of cardiorenal syndrome

Cardiorenal syndrome includes a spectrum of disorders of the kidneys and heart in which loss of function in one organ contributes to reduced function in the other organ. Cardiorenal syndrome is frequently complicated by comorbid anemia, which leads to reciprocal and progressive cardiac and renal deterioration. The triad of heart failure, chronic kidney disease (CKD), and anemia is termed cardiorenal anemia syndrome (CRAS). There are currently no evidence-based recommendations for managing patients with CRAS; however, the treatment of these patients is multifactorial. Not only must the anemia be controlled, but heart failure and kidney injury must be addressed, in addition to other comorbidities. Intravenous iron and erythropoiesis-stimulating agents are the mainstays of treatment for anemia of CKD, addressing both iron and erythropoiesis deficiencies. Since erythropoiesis-stimulating agent therapy can be associated with adverse outcomes at higher doses in patients with CKD and is not used in routine practice in patients with heart failure, treatment options for managing anemia in patients with CRAS are limited. Several new therapies, particularly the hypoxia-inducible factor-prolyl hydroxylase inhibitors, are currently under clinical development. The hypoxia-inducible factor-prolyl hydroxylase inhibitors have shown promising results for treating anemia of CKD in clinical trials and may confer benefits in patients with CRAS, potentially addressing some of the limitations of erythropoiesis-stimulating agents. Updated clinical practice guidelines for the screening and management of anemia in cardiorenal syndrome, in light of potential new therapies and clinical evidence, would improve the clinical outcomes of patients with this complex syndrome.

Acute cardiorenal anemia syndrome among ST-elevation myocardial infarction patients treated by primary percutaneous intervention.

Acute kidney injury (AKI) and anemia have been extensively studied in ST-elevation myocardial infarction (STEMI), yet the precise nature of their reciprocal relationship has not been elucidated in STEMI patients. We performed a retrospective analysis of 2096 consecutive patients admitted for STEMI between January 2008 and December 2018 and treated with primary coronary intervention. Patients were stratified into four groups according to the presence of baseline anemia and occurrence of AKI: without anemia or AKI, baseline anemia without AKI, AKI without baseline anemia and acute cardiorenal anemia syndrome (CRAS), defined as the occurrence of AKI in patients with baseline anemia. Patients' medical records were reviewed for in-hospital complications, 30-day and long-term mortality. The mean age was 61 ± 13 years and 1682 patients (80%) were men. Ten percent of patients had baseline anemia without AKI, 7% had AKI without baseline anemia and 3% were classified as CRAS. We found increments between the four groups for occurrence of new onset atrial fibrillation and heart failure rates, presence of a critical state, and both 30-day and long-term mortality (P < 0.001 for all). Logistic regression models demonstrated that as compared to AKI alone, CRAS was associated with a higher risk for long-term mortality (HR 10.49; 95% CI 6.5-17.1) as compared to anemia (HR 3.32, 95% CI 2.1-5.2) and AKI (HR 7.71, 95% CI 5.1-11.7) alone (P < 0.001 for all). Among STEMI patients, the interaction between anemia and AKI is associated with worse short and long-term outcomes and reflects the reciprocity of cardiac and renal exacerbations.

The CRAS-EAHFE study: Characteristics and prognosis of acute heart failure episodes with cardiorenal-anaemia syndrome at the emergency department.

The coexistence of other comorbidities confers poor outcomes in patients with acute heart failure. Our aim was to determine the characteristics of patients with acute heart failure and cardiorenal anaemia syndrome and the relationship between renal dysfunction and anaemia, alone or combined as cardiorenal anaemia syndrome, on short-term outcomes. We analysed the Epidemiology of Acute Heart Failure in Emergency Departments registry (cohort of patients with acute heart failure in Spanish emergency departments). Renal dysfunction was defined by an estimated glomerular filtration rate <60 ml/min/m2, anaemia by haemoglobin values <12/<13 g/dl in women/men, and cardiorenal anaemia syndrome as the presence of both. Comparisons were made according to cardiorenal-anaemia syndrome positive (CRAS+) with respect to the rest of patients (CRAS-) and according the presence of renal dysfunction (RD+) and anaemia (A+), (alone, RD+/A-, RD-/A+) or in combination (RD+/A+; i.e. CRAS+) with respect to patients without renal dysfunction and anaemia (RD-/A-). The primary outcome was 30-day mortality, and the secondary outcomes were need for admission, prolonged hospitalisation (>10 days), in-hospital mortality during the index event, and reconsultation and the combination of 30-day post-discharge reconsultation/death. These short-term outcomes were compared and adjusted for differences among groups. Of the 13,307 patients analysed, CRAS+ (36.4%) was associated with older age, multiple comorbidities, chronic use of loop diuretics, oedemas and hypotension. The 30-day mortality in CRAS+ was greater than in CRAS- (hazard ratio = 1.46, 95% confidence interval = 1.26-1.68) and RD-/A- (hazard ratio = 1.83, 95% confidence interval = 1.46-2.28) control groups. The mortality level was also higher in RD+/A- (hazard ratio = 1.40, 95% confidence interval = 1.10-1.78) and higher, but not statistically significant, in RD-/A+ (hazard ratio = 1.28, 95% confidence interval = 0.99-1.63) with respect to RD-/A-. All of the secondary outcomes, when related to CRAS- and RD-/A- control groups, were worse for CRAS+ and to a lesser extent, RD+/A-, being more rarely observed in RD-/A+. Cardiorenal anaemia syndrome in acute heart failure is related to greater mortality and worse short-term outcomes, and the impact of renal dysfunction and anaemia seems to be additive.

INDOXYL SULFATE IS A KEY PLAYER IN THE CARDIORENAL ANEMIA SYNDROME AND PREDICTS THE CLINICAL OUTCOME AFTER ACUTE DECOMPENSATED HEART FAILURE

The cardiorenal anemia syndrome is a prognostic factor in patients with heart failure. However, little has been investigated whether circulating uremic toxins impact in the underlying mechanism. Indoxyl sulfate (IS), a protein bound uremic toxin is known to suppress hemotopoietic capacity with

Síndrome cardiorrenal em cães: a busca por medidas de controle

A relação fisiopatológica entre os rins e o coração na doença, conhecida como síndrome cardiorrenal (SCR), envolve distúrbios do coração e dos rins, pois a disfunção aguda ou crônica em um órgão pode induzir a disfunção aguda ou crônica do outro. Em Medicina Veterinária são descritos 5 subtipos de síndrome cardiorrenal: cardiorrenal aguda, cardiorrenal crônica, renocárdica aguda, renocárdica crônica e secundária. A anemia é um achado comum em cães com disfunção cardíaca e renal, caracterizando a chamada síndrome da anemia cardiorrenal. Os mecanismos envolvidos na fisiopatologia da síndrome cardiorrenal envolvem, não somente alterações hemodinâmicas e ativação de sistemas neuro-hormonais, como também a ativação de mecanismos compensatórios do próprio organismo, que acabam contribuindo para a piora da função cardíaca e renal, levando ao desenvolvimento da SCR. O grande desafio encontrado em Medicina Veterinária está relacionado ao diagnóstico precoce dessa síndrome e, principalmente, ao correto manejo terapêutico, uma vez que que a terapia da cardiopatia pode deteriorar a função renal, e vice-versa. Portanto, é importante compreender como a fisiopatologia de uma doença pode impactar a função do outro órgão. O presente trabalho tem como objetivo trazer uma completa abordagem da fisiopatologia, diagnóstico e tratamento da síndrome cardiorrenal em cães.

HYPERTENSION AS A PREDICTOR IN-HOSPITAL MORTALITY AMONG PATIENTS HAVING CONGESTIVE HEART FAILURE

Background; Hypertension remains an important risk factor which contributes towards the worsening of the outcomes, consisting of cardio-renal anemia syndrome and its impact in heart failure remains to be complex and multifactorial. The current study was done to evaluate the role of hypertension on mortality among patients having congestive heart failure. Material and methods; This study included a total of 115 patients with congestive heart failure presenting at Nishtar Hospital Multan. These patients were followed till discharge to document in-hospital mortality during current hospitalization. All the sociodemographic distribution and other relevant information such as age, gender, area of residence, diabetes, hypertension, obesity, smoking, hyperlipidemia and mortality were noted in the proforma and data was entered and analyzed by SPSS version 22 for descriptive statistics and tests of significance. hypertension was cross-tabulated against in-hospital mortality using two by two table and chi-square test was applied at level of significance of 0.05. Results; Among our 115 patients with congestive heart failure, 75 (65.2%) were males and 40 (34.8%) were females. Mean age of our patients with CHF was 57.17 ± 11.65 years ranging from 34 to 80 years. Although males were younger than female patients with congestive heart failure but this difference was not statistically significant (p=0.140). Seventy five (65.2%) were from rural areas, 40 (34.8%) were poor, 70 (60.9%) from middle income families and only 5 (4.3%) belonged to rich families. Mean body mass index (BMI) of patients with congestive heart failure was 26.12 ± 2.93 kg/m 2 and 35 (30.4%) were obese. Twenty five (21.7%) were smokers. Forty five (39.1%) had diabetes and 55 (47.8%) had hypertension. In-hospital mortality in patients with congestive heart failure was 12 (10.4%) and of these 12 mortalities, hypertension was noted in 11 (92 %) patients. Conclusion; Our study results have documented high frequency of hypertension among patients with congestive heart failure and hypertension was significantly associated with in – hospital mortality. Keywords; Congestive Heart Failure, hypertension, in-hospital mortality. DOI : 10.7176/JMPB/55-07 Publication date :May 31 st 2019

Brain Natriuretic Peptide (BNP) and N-Terminal-proBNP in Cardio-Renal Anemia Syndrome ― Difference in Prognostic Ability ―

Background: Cardio-renal anemia syndrome (CRAS) is a growing health problem, with a high mortality rate. Brain natriuretic peptide (BNP) and N-terminal proBNP (NT-proBNP) are well-established diagnostic and prognostic biomarkers of heart failure (HF). The difference in the clinical significance of these biomarkers, however, has not yet been completely elucidated in HF. The aim of the present study was to compare the prognostic ability of BNP and NT-proBNP in HF patients with CRAS. Methods and Results: We measured BNP and NT-proBNP in 492 consecutive HF patients and in 17 control subjects. All patients were prospectively followed up during a median follow-up period of 1,034 days. NT-proBNP/BNP ratio was elevated in HF patients with CRAS compared with those without CRAS and the control subjects. There was no significant difference in the prognostic abilities of BNP and NT-proBNP in all HF patients. The C-index for NT-proBNP for predicting cardiovascular events and mortality, however, was significantly higher than that for BNP in HF patients with CRAS. On multivariate Cox proportional hazards-regression analysis, NT-proBNP, but not BNP, was an independent predictor for clinical outcome in HF with CRAS. Conclusions: The difference in the prognostic abilities of BNP and NT-proBNP was high in HF patients with CRAS. NT-proBNP had a superior prognostic ability to BNP in HF patients with CRAS.

Incidence and impact of cardiorenal anaemia syndrome on all-cause mortality in acute heart failure patients stratified by left ventricular ejection fraction in the Middle East.

AimsThis study aims to evaluate the incidence and impact of cardiorenal anaemia syndrome (CRAS) on all‐cause mortality in acute heart failure (AHF) patients stratified by left ventricular ejection fraction (LVEF) status in the Middle East.Methods and resultsData were analysed from 4934 consecutive patients admitted to 47 hospitals in seven Middle Eastern countries (Saudi Arabia, Oman, Yemen, Kuwait, United Arab Emirates, Qatar, and Bahrain) with AHF from February to November 2012. CRAS was defined as AHF with estimated glomerular filtration rate of <60 mL/min and low haemoglobin (<13 g/dL for men or <12 g/dL for women). Analyses were performed using univariate and multivariate statistical techniques. The overall mean age of the cohort was 59 ± 15 years, 62% (n = 3081) were men, and 27% (n = 1319) had CRAS. Co‐morbid conditions were common including hypertension (n = 3014; 61%), coronary artery disease (n = 2971; 60%), and diabetes mellitus (n = 2449; 50%). A total of 79% (n = 3576) of the patients had AHF with reduced ejection fraction (HFrEF) (LVEF < 50%). CRAS patients were associated with major bleeding (1.29% vs. 0.6%; P = 0.017), blood transfusion (10.1% vs. 3.0%; P < 0.001), higher re‐admission rate for AHF at 3 months' follow‐up (27.6% vs. 18.8%; P < 0.001) and at 12 months' follow‐up (34.3% vs. 26.2%; P < 0.001). Multivariate logistic regression demonstrated that patients with CRAS were associated with higher odds of all‐cause mortality during hospital admission [adjusted odds ratio (aOR), 2.10; 95% confidence interval (CI): 1.34–3.31; P = 0.001], at 3 months' follow‐up (aOR, 1.48; 95% CI: 1.07–2.06; P = 0.018), and at 12 months' follow‐up (aOR, 1.45; 95% CI: 1.12–1.87; P = 0.004). Stratified analyses showed that CRAS patients with HFrEF were associated with higher odds of all‐cause mortality during hospital admission (aOR, 2.03; 95% CI: 1.20–3.45; P = 0.009) and at 12 months' follow‐up (aOR, 1.42; 95% CI: 1.06–1.89; P = 0.019) but not at 3 months' follow‐up (aOR, 1.43; 95% CI: 0.98–2.09; P = 0.063). However, in AHF patients with preserved ejection fraction (LVEF ≥ 50%), CRAS was not associated with higher odds of all‐cause mortality not only during hospital admission (aOR, 2.15; 95% CI: 0.84–5.55; P = 0.113) but also at 3 months' follow‐up (aOR, 1.87; 95% CI: 0.93–3.76; P = 0.078) and at 12 months' follow‐up (aOR, 1.59; 95% CI: 0.91–2.76; P = 0.101).ConclusionsThe incidence of CRAS was 27%. CRAS was associated with higher odds of all‐cause mortality in AHF patients in the Middle East, especially in those with HFrEF.

La sindrome anemica cardio-renale. Terza parte: Terapia

Cardio-renal anemia syndrome. Third part: TherapyIn the previous sections of this chapter the clinical, epidemiological, pathophysiological and diagnostic aspects of cardiorenal anemia syndrome (CR...