Cardio-renal anemia syndrome. Part 3: Therapy

Abstract

In the previous sections of this chapter the clinical, epidemiological, pathophysiological and diagnostic aspects of cardiorenal anemia syndrome (CRAS) were treated. In this third and final component of the review the updates on the therapeutic aspects will be addressed. Erythropoiesis-stimulating agents (ESAs) and adjuvant iron therapy represent the primary treatment for anemia in CRS. The latest randomized trials for the treatment of iron deficiency in CRAS using intravenous (i.v.) Fe, have shown an improvement in symptoms, functional capacity and quality of life. These beneficial effects were independent of the presence of anemia. Furthermore, treatment with i.v. Fe can reduce the hospitalization rate due to the worsening of CHF. Oral iron is available at a lower cost than i.v. Fe, but its use did not translate into beneficial effects in CHF patients with iron deficiency (ID). The use of ESAs has been recently debated; the latest interventional study seems to demonstrate a neutral or negative effect in the active arm with darbepoetin treatment. These findings contrast with previous single-blind studies and meta-analyses, which showed an improvement in quality of life, left ventricular systolic function, and exercise tolerance following ESA therapy. In this review we discuss interventional studies in patients with CRAS and the potential role of ESA in this setting. (Cardionephrology)