CHF–CKD–anaemia: the vicious cycle
In CRAS, tissue hypoxia due to anaemia causes peripheral vasodilatation, reduces blood pressure and activates the sympathetic nervous system.1
- In turn, these events increase cardiac stroke volume and peripheral vasoconstriction resulting in reduced renal blood flow and renal ischaemia.1
- This activates the RAAS and antidiuretic hormone causing salt and water retention, leading to left ventricular dilatation and hypertrophy, necrosis of myocardial cells, fibrosis and cardiomyopathy, and ultimately results in CHF.2–4
Renal function in CHF primarily decreases as a result of renal hypoperfusion, but congestion (systemic and renal) also has deleterious effects on the kidney. Reduced kidney function in turn causes decreased erythropoietin production and worsens the anaemia.1
References
1. Silverberg DS et al. Int Urol Nephrol 2006;38:295-310
2. Efstratiadis G et al. Hippokratia 2008;12:11–16
3. Jie KE et al. Am J Physiol Renal Physiol 2006;291:F932–F944
4. Ronco C et al. Blood Purif 2009;27:114–126
