Dialyse aktuell 2011; 15(7): 378-383
DOI: 10.1055/s-0031-1289120
Nephrologie
© Georg Thieme Verlag Stuttgart · New York

Kardiorenales Anämiesyndrom – Was ist das?

CRAS – What is that?
Eberhard Ritz
Nierenzentrum Heidelberg e. V. (Geschäftsführer: Thomas Meyer)
› Author Affiliations
Further Information

Publication History

Publication Date:
09 September 2011 (online)

Der Begriff ”kardiorenales Anämiesyndrom“ weist auf die häufig vergesellschaftete, sich gegenseitig verstärkende, Beziehung zwischen eingeschränkter Herzfunktion, eingeschränkter Nierenfunktion und Anämie hin. Diese Klassifizierung ist nützlich, da sie Hinweise auf Therapieoptionen gibt, obwohl diese noch gegenwärtig sich nur teilweise auf kontrollierte Evidenz stützen können.

The term CRAS (”Cardiorenal Anemia Syndrome“) refers to the frequent coexistence of reduced cardiac function, reduced renal function and anemia. This classification is useful because it points to therapeutic options, although admittedly the evidence for the efficacy of this intervention is currently still incomplete.

 
  • Literatur

  • 1 Sandhu A, Soman S, Hudson M, Besarab A. Managing anemia in patients with chronic heart failure: what do we know?. Vasc Health Risk Manag 2010; 6: 237-252
  • 2 Felker GM, Shaw LK, Stough WG, O'Connor CM. Anemia in patients with heart failure and preserved systolic function. Am Heart J 2006; 151: 457-462
  • 3 Young JB, Abraham WT, Albert NM et al. Relation of low hemoglobin and anemia to morbidity and mortality in patients hospitalized with heart failure (insight from the OPTIMIZE-HF registry). Am J Cardiol 2008; 101: 223-230
  • 4 Tang WH, Tong W, Jain A et al. Evaluation and long-term prognosis of new-onset, transient, and persistent anemia in ambulatory patients with chronic heart failure. J Am Coll Cardiol 2008; 51: 569-576
  • 5 He SW, Wang LX. The impact of anemia on the prognosis of chronic heart failure: a meta-analysis and systemic review. Congest Heart Fail 2009; 15: 123-130
  • 6 Witte KK, Desilva R, Chattopadhyay S et al. Are hematinic deficiencies the cause of anemia in chronic heart failure?. Am Heart J 2004; 147: 924-930
  • 7 Smith GL, Lichtman JH, Bracken MB et al. Renal impairment and outcomes in heart failure: systematic review and meta-analysis. J Am Coll Cardiol 2006; 47: 1987-1996
  • 8 McClellan WM, Flanders WD, Langston RD et al. Anemia and renal insufficiency are independent risk factors for death among patients with congestive heart failure admitted to community hospitals: a population-based study. J Am Soc Nephrol 2002; 13: 1928-1936
  • 9 Tanner H, Moschovitis G, Kuster GM et al. The prevalence of anemia in chronic heart failure. Int J Cardiol 2002; 86: 115-121
  • 10 McClellan WM, Langston RD, Presley R. Medicare patients with cardiovascular disease have a high prevalence of chronic kidney disease and a high rate of progression to end-stage renal disease. J Am Soc Nephrol 2004; 15: 1912-1919
  • 11 Hillege HL, Girbes AR, de Kam PJ et al. Renal function, neurohormonal activation, and survival in patients with chronic heart failure. Circulation 2000; 102: 203-210
  • 12 Foley RN, Murray AM, Li S et al. Chronic kidney disease and the risk for cardiovascular disease, renal replacement, and death in the United States Medicare population, 1998 to 1999. J Am Soc Nephrol 2005; 16: 489-495
  • 13 Silverberg DS, Wexler D, Iaina A, Schwartz D. The role of correction of anaemia in patients with congestive heart failure: a short review. Eur J Heart Fail 2008; 10: 819-823
  • 14 Mozaffarian D, Nye R, Levy WC. Anemia predicts mortality in severe heart failure: the prospective randomized amlodipine survival evaluation (PRAISE). J Am Coll Cardiol 2003; 41: 1933-1939
  • 15 Anand IS, Kuskowski MA, Rector TS et al. Anemia and change in hemoglobin over time related to mortality and morbidity in patients with chronic heart failure: results from Val-HeFT. Circulation 2005; 112: 1121-1127
  • 16 Brucks S, Little WC, Chao T et al. Relation of anemia to diastolic heart failure and the effect on outcome. Am J Cardiol 2004; 93: 1055-1057
  • 17 Adams Jr. KF et al. Prospective assessment of the occurrence of anemia in patients with heart failure: results from the Study of Anemia in a Heart Failure Population (STAMINA-HFP) Registry. Am Heart J 2009; 157: 926-932
  • 18 Lindenfeld J. Prevalence of anemia and effects on mortality in patients with heart failure. Am Heart J 2005; 149: 391-401
  • 19 Scrutinio D, Passantino A, Santoro D, Catanzaro R et al. The cardiorenal anaemia syndrome in systolic heart failure: prevalence, clinical correlates, and long-term survival. Eur J Heart Fail 2011; 13: 61-67
  • 20 Muzzarelli S, Pfisterer M. TIME Investigators.. Anemia as independent predictor of major events in elderly patients with chronic angina. Am Heart J 2006; 152: 991-996
  • 21 Ezekowitz JA, McAlister FA, Armstrong PW. Anemia is common in heart failure and is associated with poor outcomes: insights from a cohort of 12 065 patients with new-onset heart failure. Circulation 2003; 107: 223-225
  • 22 Levin A. The need for optimal and coordinated management of CKD. Kidney Int Suppl 2005; 99
  • 23 Collins AJ, Li S, Gilbertson DT et al. Chronic kidney disease and cardiovascular disease in the Medicare population. Kidney Int Suppl 2003; 87
  • 24 Jie KE, Verhaar MC, Cramer MJ et al. Erythropoietin and the cardiorenal syndrome: cellular mechanisms on the cardiorenal connectors. Am J Physiol Renal Physiol 2006; 291
  • 25 von Haehling S, Schefold JC, Hodoscek LM et al. Anaemia is an independent predictor of death in patients hospitalized for acute heart failure. Clin Res Cardiol 2010; 99: 107-113
  • 26 Beck da Silva L, Rohde LE, Clausell N. Etiology and management of anemia in patients with heart failure: how much iron is missing?. Congest Heart Fail 2008; 14: 25-30
  • 27 Palazzuoli A, Silverberg D, Iovine F et al. Erythropoietin improves anemia exercise tolerance and renal function and reduces B-type natriuretic peptide and hospitalization in patients with heart failure and anemia. Am Heart J 2006; 152: 9-15
  • 28 Ghali JK, Anand IS, Abraham WT et al. Randomized double-blind trial of darbepoetin alfa in patients with symptomatic heart failure and anemia. Circulation 2008; 117: 526-535
  • 29 van Veldhuisen DJ, Dickstein K, Cohen-Solal A et al. Randomized, double-blind, placebo-controlled study to evaluate the effect of two dosing regimens of darbepoetin alfa in patients with heart failure and anaemia. Eur Heart J 2007; 28: 2208-2016
  • 30 Ponikowski P, Anker SD, Szachniewicz J et al. Effect of darbepoetin alfa on exercise tolerance in anemic patients with symptomatic chronic heart failure: a randomized, double-blind, placebo-controlled trial. J Am Coll Cardiol 2007; 49: 753-762
  • 31 Lawler PR, Filion KB, Eisenberg MJ. Correcting anemia in heart failure: the efficacy and safety of erythropoiesis-stimulating agents. J Card Fail 2010; 16: 649-658
  • 32 Abraham WT, Anand IS, Klapholz M et al. Treatment of anemia with darbepoetin alfa in heart failure. Congest Heart Fail 2010; 16: 87-95
  • 33 Palazzuoli A, Silverberg DS, Iovine F et al. Effects of beta-erythropoietin treatment on left ventricular remodeling, systolic function, and B-type natriuretic peptide levels in patients with the cardiorenal anemia syndrome. Am Heart J 2007; 154: 9-15
  • 34 Ponikowski P, Jankowska EA. EPO's rescue mission in acute myocardial infarction: still more hopes than evidence. Eur Heart J 2010; 31: 2577-2579
  • 35 Parsa CJ, Matsumoto A, Kim J et al. A novel protective effect of erythropoietin in the infarcted heart. J Clin Invest 2003; 112: 999-1007
  • 36 Voors AA, Belonje AM, Zijlstra F et al. A single dose of erythropoietin in ST-elevation myocardial infarction. Eur Heart J 2010; 31: 2593-2600
  • 37 Ozawa T, Toba K, Suzuki H et al. Single-dose intravenous administration of recombinant human erythropoietin is a promising treatment for patients with acute myocardial infarction - randomized controlled pilot trial of EPO/AMI-1 study. Circ J 2010; 74: 1415-1423
  • 38 Anker SD, Voors A, Okonko D et al. Prevalence, incidence, and prognostic value of anaemia in patients after an acute myocardial infarction: data from the OPTIMAAL trial. Eur Heart J 2009; 30: 1331-1339
  • 39 Okonko DO, Grzeslo A, Witkowski T et al. Effect of intravenous iron sucrose on exercise tolerance in anemic and nonanemic patients with symptomatic chronic heart failure and iron deficiency FERRIC-HF: a randomized, controlled, observer-blinded trial. J Am Coll Cardiol 2008; 51: 103-112
  • 40 Bolger AP, Bartlett FR, Penston HS et al. Intravenous iron alone for the treatment of anemia in patients with chronic heart failure. J Am Coll Cardiol 2006; 48: 1225-1257
  • 41 Jankowska EA, Rozentryt P, Witkowska A et al. Iron deficiency: an ominous sign in patients with systolic chronic heart failure. Eur Heart J 2010; 31: 1872-1880
  • 42 Anker SD, Comin JColet, Filippatos G et al. Ferric carboxymaltose in patients with heart failure and iron deficiency. N Engl J Med 2009; 361: 2436-2448
  • 43 McCullough PA. Prevention of cardiorenal syndromes. Contrib Nephrol 2010; 165: 101-111
  • 44 Attanasio P, Ronco C, Anker MS et al. Management of chronic cardiorenal syndrome. Contrib Nephrol 2010; 165: 129-139