In addition, they have a more rapid deterioration in their renal function and can end up on dialysis. Many studies also demonstrate that these patients die more rapidly than their non-anemic counterparts do. Patients with CHF who are anemic are often resistant to all CHF medications resulting in being hospitalized repeatedly. We have termed this vicious circle the cardio renal anemia (CRA) syndrome. Therefore, a vicious circle is set up wherein CHF causes anemia, and the anemia causes more CHF and both damage the kidneys worsening the anemia and the CHF further. Long-standing anemia of any cause can cause left ventricular hypertrophy (LVH), which can lead to cardiac cell death through apoptosis and worsen the CHF. The anemia itself can worsen cardiac function, both because it causes cardiac stress through tachycardia and increased stroke volume, and because it can cause a reduced renal blood flow and fluid retention, adding further stress to the heart. However, anemia can occur in CHF without CKI and is likely to be due to excessive cytokine production (for example, tumor necrosis factor-alfa (TNF-alfa) and interleukin-6 (IL-6)), which is common in CHF and can cause reduced EPO secretion, interference with EPO activity in the bone marrow and reduced iron supply to the bone marrow. This reduces the amount of erythropoietin (EPO) produced in the kidney and leads to anemia. The CKI is likely to be due to the renal vasoconstriction that often accompanies CHF and can cause long-standing renal ischemia. The most likely common cause is chronic kidney insufficiency (CKI), which is present in about half of all CHF cases. Anemia is found in about one-third of all cases of congestive heart failure (CHF).
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