The effect combination therapy of erytropoietin and intravenous iron in patients by chronic heart failure with anemic syndrome

Abstract

Purpose: Anemia is associated with worse functional status greater risk of heart failure (HF) hospitalization and mortality.Causes of anemia is erythropoietin failure,iron deficiency.Iron deficiency may independently contribute to muscle dysfunction in HF and causes anaemia.Therefore,our aim was to perfom the study to determine, the effect of iron and methoxsypoliethylenglicol-epoietin- β (Mircera) combination therapy on mortality,hospitalization and adverse events in patients with CHF.Methods: Randomised clinical trials comparing the effects of erythropoietin stimulating agent (ESA) and iron combination therapies in patients CHF NYHA class II-IV,LVEF ≤ 40% with iron deficiency (ID) (Hb<11g/dl were included. ID was diagnosed at serrum ferritin 30-99 ug/l or serrum ferritin 100-299 ug/l,if the transferrin saturation (TSAT) < 20%.102 patients with anemic CHF were obtained and were randomly into two groups.I groups incuded 52 patients were treated with combination treatment.II groups 50 patients with placebo.Percutaneus Mircera in dose 50 IU in day in one mounth in follow - up 6 mounths with combination of iron isomaltosid 1000 (Monofer) either as 4 intrvenous (iv) bolus injections of 100-200 mg iron per dose or as a fast high-dose infusion at baseline.Echocardiografic indices of LV systolic and diastolic fuction and RV function, plasma N terminal β-type natriuretic peptide (NT pro BNP) and 6 minute walked distance were assessed at baseline and postreatment.Results: Combination therapy had a significantly lower risk CHF hospitalisation (risk ratio (RR)=0,51 94% CI 0,38 to 2,34; p=0,05).No differences were observed in the occurence of hypertension or venous trombosis.The treatment patients with anaemic CHF with ID of combination therapy by Mircera and Maltofer there was a significant increase Hb (to 9,8±0,7 g/dl to 12,8±0,6 g/dl) (p<0,01),a significant NYHA class from 3,4±0,2 to 2,2±0,3 (p<0,05), a longer endurance on exercise testing from 243±34 to 384±75 meters (p<0,01).There was also a significant fail in serrum NT pro BNP levels from 684±108 pg/ml to 239±81pg/ml (p<0,05).Combination therapy significant reduction in plasma creatinine (p<0,01) and an increase in estimated creatinine clearance (p=0,02).Concusion: Iv-iron administration improves iron status (increased TSAT and ferritin). Percutaneus Mircera in dose 50 IU in day in one mounth in follow- up 6 mounths has improve EPO disfunction.Combination therapy has emerged as a well tolerated and effective therapy to improve symptoms and quality of life in anemic CHF patients with ID. Therefore, combination therapy of EPO and iv- iron may best.