Importance of anemia in the chronic Cardiorenal syndrome: Effects on renal function after heart transplantation

Abstract

SummaryBackgroundCardiorenal syndrome has been recently divided into 5 categories, according to acute or chronic evolution and primary organ dysfunction. Anemia can also accompany this disorder, leading to a more complex situation. This study aims to analyze the renal outcomes of patients, specifically patients with chronic Cardiorenal syndrome, with or without anemia, long-term after heart transplantation.Material/MethodsThis was a retrospective cohort study on chronic Cardiorenal syndrome patients submitted to heart transplantation. Patients were divided according to presence of anemia and renal dysfunction before heart transplantation.ResultsA total of 108 patients (92 males) with the mean age of 45±12 years were included. The etiologies of the heart failure were hypertensive dilated myocardiopathy (66%), ischemic (14%) and Chagasic (12%). Before the heart transplantation, 51 patients had an eGFR less than 60 mL/min. From these, 24 had concomitant anemia. One year after the transplantation, patients with previous isolated renal dysfunction ameliorates eGFR (45±11 vs. 65±26 mL/min, p<0.001), while those patients with previous renal dysfunction and anemia presented no improvement (eGFR 44±14 vs. 47±13 mL/min, p=0.619) 1 year after heart transplantation. Moreover, higher hemoglobin was an independent predictor of eGFR improvement after heart transplantation when associated with previous renal dysfunction (OR 1.8; CI 1.2–3.6, p<0.01 for each hemoglobin increment of 1 g/dL).ConclusionsPatients with isolated Cardiorenal syndrome presented partial renal function recovery after heart transplantation, while the presence of cardiorenal anemia was a marker of renal function non-recovery 1 year after heart transplantation.

Left ventricular assist devices: a kidney’s perspective

“…In addition, paired sample analyses combining the development of renal function following consecutive LVAD and HTx in the same patients are scant. Some research suggests that HTx following LVAD leaves the downward trend unaltered [ 71 ] although others report that HTx may temporarily increase GFR in patients with prior compromised renal function [ 72 ]. Singh et al [ 56 ] retrospectively analyzed the evolution of renal function of 116 patients consecutively undergoing MCS and HTx.…”

Síndrome cardiorrenal tipo 1 en la unidad de cuidados intensivos coronarios del Hospital Nacional Arzobispo Loayza

“…Los pacientes con hemoglobina < 10 mg/dL fueron excluidos de este estudio para evitar que pacientes con ERC no diagnosticada (que usualmente tienen hemoglobinas bajas) fueran incluidos en el mismo y también para evitar que la presencia de una baja hemoglobina sea otro factor confusor ya que al haber menos hemoglobina hay menor transporte de oxígeno y por lo tanto todos los tejidos incluidos el riñón sufren de una menor oxigenación. Sin embargo, este estudio mostró una asociación entre una mayor hemoglobina y la presencia de SCR1, que si bien no concuerda con la fisiopatología propuesta para el desarrollo de síndrome cardiorrenal en general, nos indica que en la fisiopatología del SCR1 la anemia no es una variable asociada de forma inversa (a menor hemoglobina, mayor frecuencia de síndrome cardiorrenal) como sí lo es en el síndrome cardiorrenal crónico o tipo 2 35 . Esta asociación inversa ha sido ya observada en un estudio donde se demostró que la hemoconcentración durante la primera semana de los pacientes que ingresan con falla cardíaca agudamente descompensada se asoció a una peor función renal 36 .…”

Combination of hemoglobin and left ventricular ejection fraction as a new predictor of contrast induced nephropathy in patients with non-ST elevation myocardial infarction

“…The risk of the CIN increased in the presence of chronic renal failure, diabetes mellitus (DM), congestive heart failure (CHF), advanced age, anemia, female gender, dehydration and excess usage of contrast agent [ 4 , 15 ]. It is found that presence of anemia is a marker for renal function non-recovery in a group of heart transplanted patients with cardiorenal syndrome [ 16 ].…”