Anemic-cardio-renal syndrome. Part 2: diagnostics

Abstract

In Part One of this two-part series, the clinical and epidemiological aspects of the cardiorenal anemia syndrome (CRAS) were discussed. Anemia is a complication frequently associated with chronic heart failure (CHF) and chronic kidney disease (CKD). Part Two of this review focuses on the diagnostic elements of anemia in cardiorenal syndrome (CRS). Bone marrow biopsy remains the gold standard for the assessment of iron (Fe) stores. However, many other laboratory tests are available, both biochemical and hematological, that are less invasive, more practical and useful for the diagnosis and gradation of iron deficiency (ID). Biochemical tests are based on Fe metabolism and allow the identification of ID before the onset of anemia. Hematologic examinations, on the other hand, based on the morphologic characteristics of the red blood cells are more readily available. New tests are currently available for ID diagnosis before anemia is present. All of these tests are used to determine the type and cause of anemia in a patient with CRS. Unfortunately, there is no single test capable of establishing the diagnosis of ID with or without anemia, but it is necessary to resort to a combination of assessments adapted to the patient’s specific clinical situation. Indeed, every assessment aimed at evaluating the iron profile expresses a different aspect of each compartment of the total body Fe (deposit, transport, metabolic-functional, etc.). Using the various available tests improves diagnostic specificity and enhances differential diagnosis. (Cardionephrology)