Survey On The Anemia And Renal Function Of The Hospitalized Severe Chronic Heart Failure Patients

Objective: This study is to investigate the incidents of anemia and renal dysfunction in the chronic heart failure (CHF) patients and analyze the relationship among anemia, CRF and CHF and find out the prognosis on CHF patients of the Hb level.Methods: This study selected the hospitalized NYHA III-and IV-class severe CHF patients in the First Clinical Hospital of Jilin University, Department of Cardiology, from July 1, 2009 to December 31, 2009, not including: 1). patients with secondary anemia, such as gastrointestinal bleeding, radiation therapy, chemotherapy, cancer, organ transplantation, admission to any major surgery in three months,etc. 2). patients with admission upon major surgery or trauma associated with other bleeding disorders and suicide death. 3). Patients with clear blood system diseases, such as aplastic anemia, hemolytic anemia. 4). Patients with congenital heart disease, such as ventricular septal defect, atrial septal defect and patent ductus arteriosus. 5). CHF patients caused by connective tissue disease. 6). Patients with heart disease during pregnancy. 7). Patients with primary kidney disease. 8). patients with incomplete clinical data in cardiac ultrasonography, blood and blood biochemistry. 290 patients were selected and the names, sex, age, Hb, HCT,BUN, Cr, LVEF, left ventricular end diastolic diameter, heart failure based on etiology, comorbidities, ACEI / ARB in hospital,βreceptor blocking lag and diuretic conditions, contact information, and follow-up investigations. Based on the standard of Hb <120g / L for adult males and Hb <110g / L for adult female (non pregnant), the selected patients were divided into anemic and non-anemia group with 47 patients and 243 patients respectively.Results: The clinical data shows that: 1).Overall incidence of anemia is 16.21% (47/290). 2). the average age of anemia group (71±9 years) is 6 years older than the average age of non-anemic group (65±12 years) (P <0.05). 3).Comparison between the two groups on combined diseases, anemia and diabetes constitute the combined ratio (48.94%) higher than non-anemic group (25.93%) (P <0.05).The comparison between the two groups on laboratory tests, cardiac function and renal function shows that: 1). The Hb concentration and HCT of anemia group is lower than the non-anemia group. 2). The BUN and Cr of anemia group is higher than the non-anemia group. GFR of anemia group (62.75 ml·min-1·1.73m-2) is lower than non-anemia group (104.61 ml·min-1·1.73m-2) (P <0.05), which shows that the renal function of anemia group is worse than the non-anemia group.3). The NYHA Class IV of anemia group (70.21%) is higher than the non-anemia group (52.26%) (P <0.05). 4). The LVEF of anemia group (50.53%±12.30%) is higher than the non-anemia group (40.83%±14.98%) (P <0.05), and left ventricular end diastolic diameter of anemia group (55.00cm±8.25cm) is lower than non-anemic group (58.98cm±10.93cm) (P <0.05). Further analysis shows that: NYHA III and IV levels the incidence of anemia was 10.77% and 20.63% (P <0.05); the median GFR of NYHA III and IV level was 104.82 ml·min-1·1.73m-2 and 94.8 ml·min-1·1.73m-2 ( P <0.05), and further analysis shows that NYHA IV class patients with GFR <60 ml·min-1·1.73m-2 accounted for 20.00%, and NYHA III class with GFR <60 ml·min-1·1.73m-2 accounted for 8.46%. Analysis on renal function to Hb levels shows that: the median Hb concentration values for GFR <60 ml·min-1·1.73m-2 and > 60 ml·min-1·1.73m-2 were 112.14g / L, and 151.31g / L respectively (P <0.05), which shows that the more severe degree of heart failure, the higher incidence in patients with anemia and worse kidney function. The relationship between renal function and anemia shows that, the incidence ratio of anemia is 48.84% when GFR<60 ml·min-1·1.73m-2, and 10.53% for GFR > 60 ml·min-1·1.73m-2. Follow-up investigation were carried out on the 290 CHF patients hospitalized for 15 months to 21 months, with an average follow-up time of 18 months, and the follow-up investigation ended by death of the patient. By the end of follow-up investigations, 70 patients died and 25 patients were lost with a loss rate of 8.62%. Except the 25 missing patients, the total mortality rate was 26.42% (70/165). The remaining 265 patients were divided into anemia group and non-anemic group. The mortality rate of anemia is 56.10% (P <0.05), and the non-anemia group is 20.98%. The anemia group mortality was significantly higher than non-anemic group. The Logistic regression analysis of risk factors for hospital death was carried out the 265 CHF patients with the age, Hb concentration, cardiac function, GFR as the covariates, and death as the dependent variable, which shows that the decrease of Hb concentration is the risk factor to increase the mortality rate of discharged CHF patients.Conclusion: This study suggests: anemia and renal dysfunction is popular in the pathogenesis of CHF patients; heart failure and renal failure are important risk factors for anemia. The three are close with interactions and form vicious circle. The mortality of CHF patients combined with anemia is higher, and the decrease of Hb concentration is the risk factor to increase the mortality rate of discharged CHF patients.