The role of Ferinject in the management of anemia in cardiorenal syndrome

Abstract

Background. Cardiorenal syndrome (CRS) includes a spectrum of renal and cardiac disabilities, where loss of function of one organ contributes to diminished function of the other. Cardiorenal syndrome is frequently complicated by comorbid anemia leading to reciprocal and progressive cardiac and renal damage. Objective(s). Presentation of the clinical case of a man inpatient in Cardiorecovery ward of the "Saint Trinity" hospital with Anemia in cardiorenal syndrome (CRAS) brought under control by i/v iron administration. Materials and methods. A 69-year-old man presents with palpitations, general weakness, dyspnea, and retrosternal pain on light physical exertion. Anamnestic, clinical, and laboratory data were obtained from the medical record. The patient was monitored by ECG and laboratory tests; he was diagnosed with HTN, DM type 2, chronic HF NYHA III st. C ACC/AHA, CKD st. III KDIGO. Results. After analyzing the history, it was determined that he was a patient with chronic CRS type II. Upon admission, an ECG was performed with atrial fibrillation rhythm, and blood tests were taken: Hb - 76 g/l, urea - 20.97 mmol/l, creatinine - 198.1 mmol/l, eGFR - 31 ml/min/1.73m2, NT-proBNP - 3290.37 pg/ml, elevated Cystatin C. During hospitalization, Ferinject 500 mg was administered with a gradual increase in Hb: 82 g/l – day 1, day 2 - 85 g/l and at discharge 95 g/l; reticulocyte storm: reticulocytes 24.8, RET-He 31.0, RBCHe 27.5, IRF 13.7%, LFR 86.3% and urea – 14.09 mmol/l, creatinine – 149.9 mmol/l, Fe – 9.2 qmol/l, Ferritin – 321 ng/ml. Conclusion(s). Screening of Hb, ferritin, transferrin saturation and serum Fe in elderly patients with CRS, and CV and metabolic comorbidities in the prevention of anemia, can contribute to improving symptoms and functional capacity, reducing the number of hospitalizations and improving quality of life.