Anemia e insuficiencia cardíaca con fracción de eyección conservada en pacientes adultos con síndrome cardiorrenal

Abstract

Introduction: Patients hospitalized for heart failure with preserved ejection fraction (HFpEF) have a higher prevalence of anemia than those hospitalized for heart failure with reduced ejection fraction (HFpEF). However, it is unknown if this relationship is maintained in patients with chronic kidney disease, forming cardiorenal syndrome type IV.Methods: Cross-sectional, multicenter study of patients with chronic kidney disease hospitalized for heart failure. The primary outcome was the difference in hemoglobin concentration. The secondary outcome was the difference in the prevalence of anemia.Results: 229 patients were enrolled. Hemoglobin concentration was lower in patients with HFpEF compared to patients with HFrEF (11.1±1.8 g/dl vs 12.3±2.0 g/dl; p < 0.0001). . Presenting HFpEF was associated with a lower hemoglobin concentration (β1 = -0.90 g/dl; p = 0.001), after including the use of iron supplements, moderate to severe deterioration of glomerular filtration rate, sex and age. The prevalence of anemia was higher in patients with HFpEF compared to those with HFrEF (72.3% vs 59.8%; p = 0.0462). Belonging to the HFpEF group was not associated with anemia (OR = 1.77; p = 0.078), after including the same covariates. Exploratory, belonging to the HFpEF group was associated with moderate to severe anemia, after including the same covariates.Conclusion: In patients with type IV cardiorenal syndrome, hemoglobin concentration is lower in patients hospitalized with HFpEF, possibly playing a role in the destabilization of these patients.Introduction: Patients hospitalized for heart failure with preserved ejection fraction (HFpEF) have a higher prevalence of anemia than those hospitalized for heart failure with reduced ejection fraction (HFpEF). However, it is unknown if this relationship is maintained in patients with chronic kidney disease, forming cardiorenal syndrome type IV. Methods: Cross-sectional, multicenter study of patients with chronic kidney disease hospitalized for heart failure. The primary outcome was the difference in hemoglobin concentration. The secondary outcome was the difference in the prevalence of anemia. Results: 229 patients were enrolled. Hemoglobin concentration was lower in patients with HFpEF compared to patients with HFrEF (11.1±1.8 g/dl vs 12.3±2.0 g/dl; p < 0.0001). Presenting HFpEF was associated with a lower hemoglobin concentration (β1 = -0.90 g/dl; p = 0.001), after including the use of iron supplements, moderate to severe deterioration of glomerular filtration rate, sex and age. The prevalence of anemia was higher in patients with HFpEF compared to those with HFrEF (72.3% vs 59.8%; p = 0.0462). Belonging to the HFpEF group was not associated with anemia (OR = 1.77; p = 0.078), after including the same covariates. Exploratory, belonging to the HFpEF group was associated with moderate to severe anemia, after including the same covariates. Conclusion: In patients with type IV cardiorenal syndrome, hemoglobin concentration is lower in patients hospitalized with HFpEF, possibly playing a role in the destabilization of these patients.Introdução: Pacientes hospitalizados por insuficiência cardíaca com fração de ejeção preservada (ICFEp) apresentam maior prevalência de anemia do que aqueles hospitalizados por insuficiência cardíaca com fração de ejeção reduzida (ICFEp). Entretanto, não se sabe se essa relação se mantém em pacientes com doença renal crônica, formando a síndrome cardiorrenal tipo IV. Métodos: Estudo transversal e multicêntrico de pacientes com doença renal crônica internados por insuficiência cardíaca. O desfecho primário foi a diferença na concentração de hemoglobina. O desfecho secundário foi a diferença na prevalência de anemia. Resultados: 229 pacientes foram incluídos. A concentração de hemoglobina foi menor em pacientes com ICFEp em comparação com pacientes com ICFEr (11,1±1,8 g/dl vs 12,3±2,0 g/dl; p < 0,0001). Presentar IC-FEc estaba asociado a una menor concentración de hemoglobina (β1 = -0,90 g/dl; p = 0,001), luego de incluir el uso de suplementos de hierro, el deterioro moderado a grave del filtrado glomerular, el sexo y idade. A prevalência de anemia foi maior em pacientes com ICFEp em comparação com aqueles com ICFEr (72,3% vs 59,8%; p = 0,0462). Pertencer ao grupo ICFEP não se associou à anemia (OR = 1,77; p = 0,078), após inclusão das mesmas covariáveis. Exploratório, pertencer ao grupo ICFEP foi associado à anemia moderada a grave, após inclusão das mesmas covariáveis. Conclusão: Em pacientes com síndrome cardiorrenal tipo IV, a concentração de hemoglobina é menor em pacientes hospitalizados com ICFEP, possivelmente desempenhando um papel na desestabilização desses pacientes.