Tratamiento de la anemia en el síndrome cardiorrenal

Anemia is a negative prognostic marker in patients with chronic heart failure, whether the ejection fraction is depressed or preserved. The majority of patients with chronic heart failure and anemia present with chronic renal failure. These three conditions (i.e. heart failure, kidney failure and anemia) are interrelated and self-perpetuating. The combination is known as cardiorenal anemia syndrome. Conversely, iron deficiency is common in patients with chronic heart failure and is believed to have a multifactorial origin. Therefore, recommended treatment for anemia in these patients is based on the administration of erythropoiesis-stimulating agents and iron therapy. The most commonly used agents in our field are recombinant human epoetin beta, darbepoetin alfa and continuous erythropoietin receptor activators. Most research shows that these agents increase hemoglobin levels, reduce levels of risk markers such as N-terminal probrain natriuretic peptide (NT-proBNP) and improve functional capacity. Some studies even show favorable changes in cardiac remodeling parameters. Iron therapy primarily involves iron sucrose and ferric carboxymaltose. Randomized placebo-controlled trials show that, in patients with iron deficiency, these compounds increase hemoglobin levels, improve functional class and 6-min walk test results, decrease the levels of risk markers such as natriuretic peptides, and improve quality of life as assessed using both specific questionnaires for patients with chronic heart failure and generic questionnaires. However, no well-designed studies have been carried out in a sufficiently large number of patients using «hard» primary endpoints. It is to be hoped that well-designed trials that include assessments of all key variables (i.e. rehospitalization, death and long-term safety) will be carried out in coming years.