Iaina Adrian, Silverberg Donald S, Wexler Dov
Department of Nephrology, Tel Aviv Medical Center, Tel Aviv, Israel.
Nat Clin Pract Cardiovasc Med. 2005 Feb;2(2):95-100. doi: 10.1038/ncpcardio0094.
Congestive heart failure (CHF) and chronic kidney disease (CKD) often progress to end stage even with optimum medical therapy. One factor that is common to both conditions is anemia, which is present in about a third of CHF patients. CHF can cause or worsen both anemia and CKD, and CKD can cause or worsen both anemia and CHF. Thus, a vicious circle exists between these three conditions, with each causing or worsening the other. We have called this condition the cardio-renal-anemia syndrome. Anemia in CHF is associated with increased mortality and hospitalization, reduced cardiac function and evidence of more severe CHF and CKD than in nonanemic patients. Intervention studies in anemic CHF patients have shown that optimum medical treatment of CHF and the correction of the associated anemia with subcutaneous erythropoietin and oral iron or intravenous iron sucrose can improve cardiac function, patients' functional status, renal function and quality of life, and reduce the frequency of hospitalization and the dose of diuretics required.
即使采用最佳的药物治疗，充血性心力衰竭（CHF）和慢性肾脏病（CKD）仍常常进展至终末期。这两种病症共有的一个因素是贫血，约三分之一的CHF患者存在贫血。CHF可导致贫血和CKD，也可使其恶化，而CKD同样可导致贫血和CHF，或使其恶化。因此，这三种病症之间存在恶性循环，每种病症都会导致或加重其他病症。我们将这种情况称为心肾贫血综合征。CHF患者的贫血与死亡率和住院率增加、心功能降低以及比非贫血患者更严重的CHF和CKD证据相关。对贫血性CHF患者的干预研究表明，对CHF进行最佳药物治疗，并通过皮下注射促红细胞生成素和口服铁剂或静脉注射蔗糖铁来纠正相关贫血，可改善心功能、患者功能状态、肾功能和生活质量，并减少住院频率和所需利尿剂剂量。
