Role of anemia in acute and chronic heart failure and the role of erythropoietin in its correction

The World Health Organization considers anemia in adults to be present when the hemoglobin (Hb) of men is <13 g/dL and of women is <12 g/dL (1). The average lower limit of a normal Hb for men and women together, therefore, is about 12.5 g/dL, and anything less than this would be considered to be anemia. In a study of 32,229 consecutive patients admitted to 263 United States hospitals with a primary diagnosis of congestive heart failure (CHF) (the Acute Decompensated Heart Failure National Registry [ADHERE] study), the mean Hb was 12.4 g/dL and the mean serum creatinine was 1.8 mg/dL (2) (roughly equivalent to a calculated creatinine clearance of about 40 mL/min/1.73 m²). Clearly, then, about half the patients admitted to hospital with a primary diagnosis of CHF in the U.S. have anemia and, since a creatinine clearance of <60 mL/min/1.73 m² is considered to be chronic kidney insufficiency (CKI), the great majority also have CKI.