Management of anemia in patients with congestive heart failure

Goodnough, Lawrence T.; Comín‐Colet, Josep; Leal-Noval, Santiago R.; Ozawa, Sherri; Takere, Jacqueline; Henry, David H.; Javidroozi, Mazyar; Hohmuth, Benjamin; Bisbe, E.; Gross, Irwin; Shander, Aryeh

doi:10.1002/ajh.24595

Cited by 50 publications

(39 citation statements)

References 59 publications

(71 reference statements)

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“…iron may improve functional status within four weeks, and reduces hospitalisations for cardiovascular reasons and mortality . In addition, improvements are maintained after 24 and 52 weeks .…”

Section: Should We Treat Iron Deficiency Without Anaemia?mentioning

confidence: 98%

An international consensus statement on the management of postoperative anaemia after major surgical procedures

Múñoz

Acheson

Bisbe³

et al. 2018

Anaesthesia

173

190

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Despite numerous guidelines on the management of anaemia in surgical patients, there is no pragmatic guidance for the diagnosis and management of anaemia and iron deficiency in the postoperative period. A number of experienced researchers and clinicians took part in a two-day expert workshop and developed the following consensus statement. After presentation of our own research data and local policies and procedures, appropriate relevant literature was reviewed and discussed. We developed a series of best-practice and evidence-based statements to advise on patient care with respect to anaemia and iron deficiency in the postoperative period. These statements include: a diagnostic approach to iron deficiency and anaemia in surgical patients; identification of patients appropriate for treatment; and advice on practical management and follow-up that is easy to implement. Available data allow the fulfilment of the requirements of Pillar 1 of Patient Blood Management. We urge national and international research funding bodies to take note of these recommendations, particularly in terms of funding large-scale prospective, randomised clinical trials that can most effectively address the important clinical questions and this clearly unmet medical need.

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Section: Should We Treat Iron Deficiency Without Anaemia?mentioning

confidence: 98%

An international consensus statement on the management of postoperative anaemia after major surgical procedures

Múñoz

Acheson

Bisbe³

et al. 2018

Anaesthesia

173

190

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“…In patients with stages 4 and 5 CKD, metabolic abnormalities, anaemia, uraemic toxins, sympathetic overactivity and volume dysregulation all likely play a role in cardiac disease. Several studies evaluating anaemia in patients with HF have shown that anaemia is both common and independently associated with increased mortality 25. However, there are no consensus guidelines on transfusion thresholds for patients with HF.…”

Section: Risk Factors For Heart Failure In Patients With Kidney Diseasementioning

confidence: 99%

Heart failure in patients with kidney disease

Tuegel

Bansal

2017

Heart

145

120

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Heart failure (HF) is a leading cause of morbidity and mortality in patients with chronic kidney disease (CKD), and the population of CKD patients with concurrent HF continues to grow. The accurate diagnosis of HF is challenging in patients with CKD in part due to a lack of validated imaging and biomarkers specifically in this population. The pathophysiology between the heart and the kidneys is complex and bidirectional. Patients with CKD have greater prevalence of traditional HF risk factors as well as unique kidney-specific risk factors including malnutrition, acid-base alterations, uraemic toxins, bone mineral changes, anemia and myocardial stunning. These risk factors also contribute to the decline of kidney function seen in patients with subclinical and clinical HF. More targeted HF therapies may improve outcomes in patients with kidney disease as current HF therapies are underutilised in this population. Further work is also needed to develop novel HF therapies for the CKD population.

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“…The symptoms associated with IDA include fatigue, palpitations, dyspnoea, headache, lack of concentration, dizziness, leg cramps, insomnia and pica . Treatment of IDA has been shown to improve energy, activity, quality of life (QOL), work capacity, cardiac function, sexual function, cognition and outcome in a variety of clinical settings …”

Section: Introductionmentioning

confidence: 99%

“…sexual function, cognition and outcome in a variety of clinical settings. [3][4][5][6][7] Oral iron is generally accepted as the treatment of choice for the majority of patients due to ease of administration, low cost and perceived effectiveness, but the incidence of side effects is considerable, thus, limiting adherence with long-term therapy. 8,9 A recent Cochrane Review raised doubts regarding the therapeutic value of oral iron for correcting postpartum anaemia.…”

mentioning

confidence: 99%

Pharmacokinetics of ferric bepectate—a new intravenous iron drug for treating iron deficiency

Múñoz

Olsen

Petersen

et al. 2019

Basic Clin Pharma Tox

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IV iron is indicated in clinical conditions, where rapid anaemia alleviation and repletion of iron stores are required. The acute toxicity of IV iron is ascribed to the presence of labile iron in plasma. Thus, shorter plasma residence time might improve the safety profile, even for compounds holding‐on the iron tightly. In this single‐centre, open‐label, single‐dose escalation study, we evaluated the elimination kinetics of ferric bepectate (FBP) compared to those of ferric carboxymaltose (FCM). Thirty‐three iron‐depleted anaemic patients who had undergone cardiac surgery were included and received 200, 500 or 1500 mg FBP or 500 mg FCM. Plasma drug curves were subjected to model‐free analysis. Because saturation kinetics was found, a compartmental model with limited elimination capacity was applied. Urinary iron excretion was also analysed. The initial non‐compartmental analysis revealed an increasing AUC/dose ratio for FBP. For both drugs, the central distribution compartment corresponded to plasma volume, and elimination followed Michaelis‐Menten saturation kinetics. Maximal elimination rates (Vmax) were 224 mg/h and 81 mg/h for FBP 500 mg and FCM 500 mg, respectively; drug concentrations at half Vmax (Km), 99 mg/L and 212 mg/L, respectively; and terminal plasma half‐life (T½), 3.05 h and 8.96 h, respectively. Both drugs were equally effective in eliciting an early ferritin rise. Urinary iron excretion was measurable in all patients receiving FCM but not in those receiving FBP, which was well tolerated. Intravenous iron drugs are subject to capacity‐limited elimination with different saturation thresholds. Urinary iron excretion can be used as a surrogate for labile plasma iron.

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Management of anemia in patients with congestive heart failure

Cited by 50 publications

References 59 publications

An international consensus statement on the management of postoperative anaemia after major surgical procedures

An international consensus statement on the management of postoperative anaemia after major surgical procedures

Heart failure in patients with kidney disease

Pharmacokinetics of ferric bepectate—a new intravenous iron drug for treating iron deficiency

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