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Heart failure
Anaemia and renal dysfunction in chronic heart failure
  1. Peter van der Meer,
  2. Dirk J van Veldhuisen
  1. Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
  1. Correspondence to Professor Dirk J van Veldhuisen, Hanzeplein 1, 9700 RB Groningen, The Netherlands; d.j.van.veldhuisen{at}

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Chronic heart failure (HF) and renal dysfunction are often seen together, and in both diseases the presence of anaemia is common and associated with an impaired outcome. This article focuses on the interaction between the heart and kidneys and the role of anaemia in this process. We will discuss the aetiology, consequences and treatment of anaemic patients with heart failure and renal dysfunction.

How common is the combination of anaemia and heart failure?

Anaemia is frequently observed in patients with chronic HF. The prevalence of anaemia depends both on the severity of chronic HF and the diagnostic criteria used to define it, but may be as high as 50% in selected patient cohorts. The criteria of the World Health Organization (haemoglobin: <12 g/dl (7.5 mmol/l) in women; <13 g/dl (8.1 mmol/l) in men) are most commonly used in the majority of studies appearing on this topic. By using this definition, Go and colleagues found in an HF registry that 22.1% of the patients were anaemic.1 A recent meta-analysis including more than 150 000 chronic HF patients revealed that 37% of chronic HF patients were considered anaemic.2 This meta-analysis also showed anaemia to be associated with a doubled mortality risk in chronic HF patients. Subgroup analysis showed no significant difference between mortality risk of anaemia in diastolic or systolic HF. Some studies have described a “J” shaped relationship between haemoglobin values and mortality. They found that the lowest mortality risk was observed in patients with haemoglobin concentrations between 14–15 g/dl (8.8–9.4 mmol/l) and that the risk increased with either lower or higher values. This finding further underscores the fact that excessive elevation of haemoglobin in anaemic patients might result in higher mortality rates.

What causes anaemia in heart failure patients?

Renal dysfunction

Reduced renal function is an important contributing factor to the anaemia observed in chronic HF patients (box 1). For estimation of the renal function several formulas have …

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  • Competing interests In compliance with EBAC/EACCME guidelines, all authors participating in Education in Heart have disclosed potential conflicts of interest that might cause a bias in the article. DJvV is a member of the Executive Committee of RED-HF.

  • Provenance and Peer review Commissioned; not externally peer reviewed.