What is the effect of anemia of chronic disease and renal failure on the risk for cardiovascular disease?

Updated: Nov 27, 2018
  • Author: Edgar V Lerma, MD, FACP, FASN, FAHA, FASH, FNLA, FNKF; Chief Editor: Emmanuel C Besa, MD  more...
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Answer

As an individual ages, the risk of death from cardiovascular disease also increases. The impact of anemia in cardiovascular disease and chronic kidney disease in this elderly population cannot be understated. Cardiovascular disease remains the most common cause of mortality in this patient population, much higher than in the general population. [36] Anemia has been shown to be an independent risk factor for increased cardiovascular morbidity and mortality.

The Dialysis Outcomes Practice Pattern Study (DOPPS) involved several countries and showed that as hemoglobin concentrations decreased to less than 11 g/dL, there was a corresponding increase in the rates of hospitalization and mortality in patients with chronic kidney disease. [37] Ofsthun et al analyzed the databases from Fresenius Medical Care of North America (FMCNA) (selection restricted to patients in the census for 6 consecutive months from July 1, 1998, through June 30, 2000) and showed that the longer it took for these patients with stage 5 chronic kidney resolve their hemoglobin concentrations from less than 11 g/dL, the more dramatic an increase in their mortality hazard ratio. [37] The investigators further added that lower hemoglobin concentrations clearly correlated positively with adverse events in these patients.

In summary, one can derive that if hemoglobin levels are maintained at the recommended target goals, these translate into decreased LVH, decreased hospitalizations related to cardiovascular disease, and decreased mortality from cardiovascular disease. Aside from these findings, however, higher quality of life (QOL) scores are also obtained: less easy fatigability and fatigue symptoms, improved physical well-being and exercise tolerance, and improved functional well-being.


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