FEATURES OF ANEMIA AND FERROKINETICS IN ELDERLY AND SENILE PATIENTS DEPENDING ON THE SEVERITY HEART FAILURE AND RENAL DYSFUNCTION
Abstract
Anemia is often present in the elderly and senile age. In 30% of cases, the anemic syndrome is caused by iron deficiency (ID), manifests iron deficiency anemia (IDA), anemia of chronic diseases (ACD), a combination of IDA and ACD and leads to an increase in morbidity and mortality. Clarification of the nature of anemia in elderly patients with CHF and CKD is necessary to optimize treatment tactics and prognosis. It has been established that anemia with impaired ferrokinetics is manifested by the development of IDA, ACID and their combination. As CKD increases, the proportion of patients with IDA decreases and the frequency of ACID and the combination of IDA and ACID increases. In CHF with a decrease in left ventricular ejection fraction, regardless of the degree of CKD, IDA predominates. The optimal method for diagnosing the combination of IDA and ACVD is the determination of the soluble transferrin receptor and ferritin index.
References
Богданов А.Н., Семелев В.Н., Тыренко В.В., Козлов К.Л. Анемический синдром и его особенности у пациентов пожилого и старческого возраста. Успехи геронтологии. СПб.: Эскулап; 2015: 124–31.
Гриншпун Л.Д., Пивник А В. Гериатрическая гематология. Заболевания системы крови в старших возрастных группах. Под ред. Л.Д. Гриншпун, А.В. Пивника. М.: Медиум. 2012; 2: 407–52.
Гуркина А.А., Стуклов Н.И., Ковальчук М.С., Драпкина О.М. Главная. Характеристика анемии при хронической сердечной недостаточности. Российское научное медицинское общество терапевтов. 2021: 21–2. https://repository.rudn.ru/ru/records/article/record/90416/
Кобалова Ж.Д., Виллевальде С.В., Ефремовцева М.А. Основы кардиоренальной медицины. М.: ГЭОТАР-Медиа; 2014: 1–256.
Basseri R.J., Nemeth E., Vassilaki M.E. et al. Hepcidin is a key mediator of anemia of inflammation in Crohn's disease. Journal of Crohn's and Colitis. 2013; 7(8): 286–91.
Blanc B., Finch C.A., Hallberg L. et al. Nutritional anaemias. Report of a WHO Scientific Group.
Bolger A.P., Bartlett F.R., Penston H.S. et al. Intravenous iron alone for the treatment of anemia in patients with chronic heart failure. Journal of the American College of the Cardiology. 2006; 48: 1225–7.
Busti F., Campostrini N. and Girelli D. Iron deficiency in the elderly population, revisited in the hepcidin era. Frontiers in Pharmacology. 2014; 5: 83.
Ganz T., Olbina G., Girelli D. et al. Immunoassay for human serum hepcidin. Blood. 2008; 112(10): 4292–7.
Graham F.J., Pellicori P., Ford I. et al. Intravenous iron for heart failure with evidence of iron deficiency: A meta-analysis of randomizedtrials. Clinical Research in Cardiology. 2021; 110: 1299–1307. DOI: 10.1007/s00392-021-01837-8.
Grebenchtchikov N., Geurts-Moespot A.J., Kroot J.J.C. et al. High-sensitive radioimmunoassay for human serum hepcidin. British Journal of Haematology. 2009; 146(3): 317–25.
Gutiérrez О.М. and al. Treatment of Iron Deficiency Anemia in CKD and End-Stage Kidney Disease. Kidney International Reports. 2021; 6(9): 2261–9.
Hoes M.F., Grote Beverborg N., Kijlstra J.D. et al. Iron deficiency impairs contractility of human cardiomyocytes through decreased mitochondrial function. European Heart Journal. 2018; 20(5): 910–9. DOI: 10.1002/ejhf.1154.
Kobak K.A., Radwańska M., et al. Structural and functional abnormalities in iron-depleted heart. Heart Fail Reviews. 2019; 24(2): 269–77. DOI: 10.1007/s10741-018-9738-4.
Kroot J.J., Laarakkers C.M., Geurts-Moespot A.J. et al. Immunochemical and mass-spectrometry-based serum hepcidin assays for iron metabolism disorders. Clinical Chemistry. 2010; 56(10): 1570–9.
Moliner P., Enjuanes C., Tajes M. et al. Association Between Norepinephrine Levels and Abnormal Iron Status in Patients With Chronic Heart Failure: Is Iron Deficiency More Than a Comorbidity? Journal of the American Heart Association. 2019; 19(8/4): 010887. DOI: 10.1161/JAHA.118.010887.
Nairz M., Theurl I., Wolf D., Weiss G. Iron deficiency or anemia of inflammation? Differential diagnosis and mechanisms of anemia of inflammation. Wien Med Wochens chr. 2016; 166(13-14): 411–23. DOI: 10.1007/s10354-016-0505-7.
National Kidney Foundation. K/DOQI Clinical Practice Guidelines for Chronic Kidney Disease: evaluation, classification, and stratification. American Journal of Kidney Diseases. 2002; 39: S1–S266.
Nemeth E., Valore E.V., Territo M. et al. Hepcidin, a putative mediator of anemia of inflammation, is a type II acute-phase protein. Blood. 2003; 101: 2461–3. DOI: 10.1182/blood-2002-10-3235.
Okonko D.O., Mandal A.K.J., Missouris C.G., Poole-Wilson P.A. Disordered iron homeostasis in chronic heart failure: Prevalence, predictors, and relation to anemia, exercise capacity, and survival. Journal of the American College of the Cardiology. 2011; 58: 1241–51. DOI: 10.1016/j.jacc.2011.04.040.
Pasricha S.R., Atkinson S.H., Armitage A.E. et al. Expression of the iron hormone hepcidin distinguishes different types of anemia in African children. Science Translational Medicine. 2014; 6(235): 235re3.
Savarese G., von Haehling S., Butler J. et al. Iron deficiency and cardiovascular disease. European Heart Journal. 2023; 44 (18/7): 1607.
Silverberg D.S., Wexler D., Blum M., Iaina A. The cardio renal anemia syndrome: correcting anemia in patients with resistant congestive heart failure can improve both cardiac and renal function and reduce hospitalizations. Clinical Nephrology. 2003; 60(1): S93–S102.
Smith G.L., Lichtman J.H., Bracken M.B., et al. Renal impairment and outcomes in heart failure: systematic review and meta-analysis. Journal of the American College of the Cardiology. 2006; 47: 1987–96.
Svenson N., Bailey J., Durairaj S., Dempsey-Hibbert N. A simplified diagnostic pathway for the differential diagnosis of iron deficiency anaemia and anaemia of chronic disease. International Journal of Laboratory Hematology. 2021; 43(6): e271–e303.
The Criteria Committee of the New York Heart Association. Nomenclature and Criteria for Diagnosis of Diseases of the Heart and Great Vessels (9th ed.). Boston: Little, Brown & Co. 1994; 253–6.
Thomas C., Kobold U., Balan S. et al. Serum hepcidin-25 may replace the ferritin index in the Thomas plot in assessing iron status in anemic patients. International Journal of Laboratory Hematology. 2011; 33(2): 187–93.
Toblli J.E., Lombrana A., Duarte P., Di Gennaro F. Intravenous iron reduces NT-pro-brain natriuretic peptide in anemic patients with chronic heart failure and renal insufficiency. Journal of the American College of the Cardiology. 2007; 50: 1657–65.
Van Der Putten K., Jie K.E., Van Den Broek D. et al. Hepcidin-25 is a marker of the response rather than resistance to exogenous erythropoietin in chronic kidney disease/chronic heart failure patients. European Journal of Heart Failure. 2010; 12: 943–50. DOI: 10.1093/eurjhf/hfq099.
Van der Wal H.H., Grote Beverborg N., Dickstein K. et al. Iron deficiency in worsening heart failure is associated with reduced estimated protein intake, fluid retention, inflammation, and antiplatelet use. European Heart Journal. 2019; 40: 3616–25. DOI: 10.1093/eurheartj/ehz680.
