Silverberg et al used the term cardio-renal anemia (CRA) syndrome to describe the interaction between chronic renal insufficiency, congestive heart failure and anemia. A patient may only respond to therapy when all 3 conditions are treated together. The authors are from Tel Aviv Medical Center in Israel.



(1) simultaneous presence of anemia, chronic renal insufficiency/failure and congestive heart failure

(2) failure to respond to standard therapy if only 1 condition is being treated

(3) response to therapy when all 3 conditions are treated aggressively and in concert


Contributing factors:

(1) concomitant iron and nutritional deficiencies

(2) worsening of anemia following therapy with ACE inhibitors (interfere with erythropoietin production and utilization)

(3) chronic GI blood loss from aspirin or other therapy

(4) diabetes mellitus

(5) reduced erythropoietin production with chronic renal insufficiency

(6) proteinuria


Treatment for the anemia may involve:

(1) maintaining adequate iron stores, which may require parenteral administration

(2) parenteral erythropoietin therapy

(3) therapy for concurrent nutritional deficiencies

(4) reducing doses or changing medications that contribute to the anemia


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