Nephrol Dial Transplant (2003) 18: 141-146
© 2003 European Renal Association-European Dialysis and Transplant Association
The effect of correction of anaemia in diabetics and non-diabetics with severe resistant congestive heart failure and chronic renal failure by subcutaneous erythropoietin and intravenous iron
Department of Nephrology and Cardiology and Congestive Heart Failure Unit, Tel Aviv Medical Center, Tel Aviv, Israel
Background. A mild anaemia is often found in patients with congestive heart failure (CHF), but its significance is uncertain. In an open uncontrolled study we investigated the effect of correcting this anaemia [haemoglobin (Hb) 9.5–11.5 g%] with subcutaneous (s.c.) erythropoietin (Epo) and intravenous (i.v.) iron (Fe) in 179 patients, 84 type II diabetics and 95 non-diabetics, with moderate to severe CHF which was resistant to maximally tolerated doses of standard CHF medications.
Methods. Epo, s.c., was given every 1–3 weeks to achieve and maintain the Hb at 12.5 g%. Fe (Fe sucrose-Venofer) was added i.v. as necessary to maintain the Fe stores. Duration of treatment was 11.8+8.2 months.
Results. With the Epo-Fe treatment the Hb increased from 10.41±1.0 to 13.1±1.3 g% in diabetics and from 10.5±1.0 to 12.9±1.2 g% in non-diabetics. Comparing the diabetics and non-diabetics, the New York Heart Association functional class improved by 34.8 and 32.4%, respectively. breathlessness and/or fatigue, as measured by a self-administered Visual Analogue Scale, improved by 69.7 and 67.4%, and the left ventricular ejection fraction improved by 7.4 and 11.5%, respectively. The number of hospitalizations fell by 96.4 and 95.3%, respectively, compared with the pre-treatment period. Although the glomerular filtration rate (GFR) was falling at a rate of 
1 ml/min/month before the study in both groups, neither the mean serum creatinine nor the GFR changed significantly during the study period. The mean dose of Epo needed, measured in IU/week/kg body weight, was similar in the two groups.
Conclusion. The correction of the mild anaemia that was found in diabetics and non-diabetics with resistant CHF and mild to moderate chronic renal failure improved the cardiac function and patient functional status, stabilized the renal function and markedly reduced the need for hospitalization.
Keywords: anaemia; chronic renal failure; diabetes mellitus; erythropoietin; heart failure; iron
Correspondence and offprint requests to: Donald S. Silverberg, Department of Nephrology and Cardiology and Congestive Heart Failure Unit, Tel Aviv Medical Center, Weizman 6, Tel Aviv 64239, Israel. Email: donald{at}netvision.net.il
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