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European Heart Journal Advance Access originally published online on December 11, 2006
European Heart Journal 2007 28(2):166-171; doi:10.1093/eurheartj/ehl419
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© The European Society of Cardiology 2006. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

Anaemia in chronic heart failure is not only related to impaired renal perfusion and blunted erythropoietin production, but to fluid retention as well

B. Daan Westenbrink1,2,*, Folkert W. Visser3, Adriaan A. Voors1, Tom D.J. Smilde1, Erik Lipsic1,2, Gerjan Navis3, Hans L. Hillege1, Wiek H. van Gilst2 and Dirk J. van Veldhuisen1

1 Department of Cardiology, University Medical Center Groningen, University of Groningen, The Netherlands
2 Department of Clinical Pharmacology, University Medical Center Groningen, University of Groningen, The Netherlands
3 Department of Nephrology, University Medical Center Groningen, University of Groningen, The Netherlands

Received 24 July 2006; revised 13 November 2006; accepted 17 November 2006; online publish-ahead-of-print 11 December 2006.

* Corresponding author: Department of Cardiology, Thoraxcenter, University Medical Center Groningen, Hanzeplein 1, PO Box 30001, 9700 RB Groningen, The Netherlands. Tel: +31 50 361 3876; fax: +31 50 361 4391. E-mail address: b.d.westenbrink{at}thorax.umcg.nl

See page 143 for the editorial comment on this article (doi:10.1093/eurheartj/ehl434)

Aims Anaemia is prevalent in the chronic heart failure (CHF) population, but its cause is often unknown. The present study aims to investigate the relation between anaemia, renal perfusion, erythropoietin production, and fluid retention in CHF patients.

Methods and results We studied 97 patients with CHF, of which 15 had anaemia (Hb < 13.0 g/dL in men and Hb < 12.0 g/dL in women), without haematinic deficiencies. Glomerular filtration rate (GFR) and extracellular volume (ECV) were measured as the clearance and the distribution volume of constantly infused 125I-iothalamate, respectively. Effective renal plasma flow (ERPF) was determined as the clearance of 131I-hippuran. Anaemic CHF patients displayed significantly reduced GFR (P = 0.002), ERPF (P = 0.005) and EPO production (P = 0.001), and an elevated ECV (P = 0.015). Multivariable analysis demonstrated that lower GFR (P = 0.003), lower ERPF (P = 0.004), lower EPO production (P = 0.006), and a higher ECV (P = 0.001) were significant independent predictors of lower haemoglobin levels.

Conclusion Anaemia in CHF is not only independently associated with impaired renal perfusion and blunted EPO production, but to fluid retention as well.

Key Words: Anaemia • Erythropoietin • Chronic heart failure • Effective renal plasma flow • Extracellular volume


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