Barcelona, Spain, 30 August: Heart failure patients may benefit from treatment of anaemia similarly to those with chronic kidney disease (CKD) or cancer.
Anaemia is common to many diseases (chronic kidney disease, cancer, chronic heart failure) as well as a consequence of treatment for diseases such as cancer, specifically with chemotherapeutic agents. Anaemia may contribute to lethargy, reduced exercise tolerance and poor quality of life. Therefore, raising haemoglobin (Hb) in anaemic patients has long been thought to be a beneficial therapeutic goal.
In contrast to CKD and cancer, attaining higher Hb targets does not appear to be associated with increased major events in early phase trials. On the other hand, the incremental benefit on exercise tolerance was also not large in these studies. Therefore, we are left with an equipoise situation in the treatment of the anaemia of heart failure, requiring a definitive outcome trial, which is currently occurring (RED-HF).
Erythropoietin is an endogenous hormone that raises Hb levels and various synthetic approaches have been developed to allow administration of this agent as a therapeutic. Improvements in patient symptom status and quality-of-life have consistently been observed in the literature with erythropoietin across a number of disease categories. However, a question has arisen as to whether there may be detrimental effects of raising Hb either too fast or to too high a level with these agents. In particular, studies in patients with anaemia of cancer and the treatment of cancer as well as with those in CKD have demonstrated that higher Hb targets are associated with adverse clinical outcomes including death and major cardiovascular events.
Prospective trials are needed to address this issue, by randomising patients to differing Hb targets and looking specifically at cardiovascular events. Such an ongoing large-scale study is TREAT, which is looking at erythropoietin in CKD patients with diabetes.