Anaemia is a relatively frequent co-morbidity of chronic heart as well as
chronic renal failure. In both conditions, it represents a strong and independent predictor of increased morbidity and mortality. Aetiology of this anaemia is multi-factorial. A number of various factors play a role in its development, e.g. inadequate
erythropoietin production in the kidneys, bone marrow inhibition,
iron deficiency as well as haemodilution associated with fluid retention. Treatment strategies aim at two directions. One is the stimulation of erythropoiesis with recombinant human
erythropoietin or its analogues such as darbepoetin alpha. The other involves
iron substitution, administered preferably intravenously for improved efficacy and tolerability. Clinical studies evaluating treatment of anaemia in chronic
heart failure with
erythropoiesis-stimulating agents conducted so far were ofa small scale, were not controlled with placebo and usually assessed proxy parameters. Their results suggested that effective treatment of anaemia in patients with chronic
heart failure improves exertion tolerance, clinical status (NYHA class) as well as the quality of life and reduces the need for
blood transfusions. Recently completed TREAT study was the first large morbidity and mortality study evaluating treatment of anaemia with an
erythropoietin analogue compared to placebo. On a sample of more than 4000 patients with
diabetes mellitus,
chronic renal failure and significant anaemia, this study has shown that effective treatment of anaemia with darbepoetin alpha did not affect at all the incidence of cardiovascular and renal events; on the other hand, it had lead to a nearly two-fold increase in the incidence of cerebrovascular events. Some doubts about the safety of treatment with
erythropoiesis-stimulating agents have occurred in the past based on the studies of anaemia treatment in patients with
cancer and renal diseases. An answer to the question whether the treatment of anaemia associated with chronic
heart failure affects positively the patient prognosis will be provided following the completion of the currently running morbidity and mortality RED-HF study.