Anaemia and the heart: what's new in 2003?

The renal community has long recognized that anaemia can impair the quality of life of patients and lead to irreversible cardiac consequences. This review examines anaemia-related outcome studies published after 2001. The profusion of observational studies in non-renal populations in 2002 has made it a remarkable year. One important community cohort study showed that 1 in 10 'healthy' adults has anaemia, an antecedent of the development of cardiovascular disease. Several cross-sectional studies have confirmed that anaemia is common in patients with congestive heart failure (CHF), and its severity correlates positively with the severity of CHF. All recent outcome studies have shown that anaemia is associated with mortality rates beyond those explicable from heart failure severity. A placebo-controlled, randomized trial showed that the normalization of haemoglobin (Hb) levels in anaemic patients with CHF improved peak oxygen uptake and exercise performance. Large clinical trials are required to define the true potential of anaemia therapy in CHF. Most renal guidelines suggest the use of Hb targets that are independent of disease stage or treatment modality. Virtually all the supportive evidence to date has been from haemodialysis populations. Anaemia, which occurs frequently and is often neglected, appears to precede left ventricular hypertrophy and CHF in renal transplant patients. Anaemia may not be an 'innocent bystander' in chronic disease; both components of the term 'anaemia of chronic disease' deserve attention.