Erythropoietin improves anemia exercise tolerance and renal function and reduces B-type natriuretic peptide and hospitalization in patients with heart failure and anemia.

Background Anemia is now recognized as being a common finding in CHF and is associated with increased mortality and morbidity. However, it is uncertain whether the anemia is actually causing the worse prognosis or is merely a marker of more severe cardiac disease. Previous intervention studies with subcutaneous (sc) β-EPO in combination with iron have either been uncontrolled or case-controlled studies. We report a randomized, double-blind, placebo-controlled study of the combination of sc EPO and oral iron versus oral iron alone in patients with anemia and resistant CHF. Objectives The present study examines, in patients with advanced congestive heart failure (CHF) and anemia, the effects of β-erythropoietin (EPO) and oral iron on the anemia and on cardiac and renal functional parameters. Methods Forty consecutive subjects with moderate to severe CHF and anemia (hemoglobin [Hb] a ) (group A, the treatment group, 20 patients) sc β-EPO for 3 months twice weekly, in addition to daily oral iron, or ( b ) (group B, the placebo group, 20 patients) normal saline in sc injections and daily oral iron. Two patients in group B were eventually excluded because of a fall of Hb Results In group A, after a mean of 3.5 ± 0.8 months of treatment, there was a significant increase in Hb from 10.4 ± 0.6 to 12.4 ± 0.8 g/dL ( P P P P o 2 ) from 12.8 ± 2.8 to 15.1 ± 2.8 mL/kg per minute ( o 2 at the anaerobic threshold, from 9.2 ± 2.0 to 13.2 ± 3.6 mL/kg minute ( P P P P P Conclusions In anemic CHF patients, correction of anemia with EPO and oral iron leads to improvement in New York Heart Association status, measured exercise endurance, oxygen use during exercise, renal function and plasma B-type natriuretic peptide levels and reduces the need for hospitalization.