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Iron Deficiency in Heart Failure

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Current Approach to Heart Failure

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Abstract

Iron deficiency (ID) represents an ominous co-morbidity prevalent in patients with heart failure (HF). Iron deficient patients with HF demonstrate reduced exercise capacity, poor quality of life, and have a higher risk of HF hospitalization and death. In clinical practice, ID can be diagnosed based on standard laboratory parameters (serum ferritin <100 μg/L, or serum ferritin between 100–299 μg/L with transferrin saturation [TSAT] <20 %, TSAT = (iron/TIBC)*100 %). Based on 2 major clinical trials (FAIR-HF and CONFIRM-HF) and other evidence, ID has been recognized as an important therapeutic target in symptomatic patients with HF and LVEF ≤45 %, both in anaemic and non-anaemic subjects, in order to alleviate HF symptoms, and improve exercise capacity and quality of life. In this chapter, we present and discuss the diagnosis of ID, its prevalence and pathophysiological background along with available therapeutic options to combat ID in patients with HF.

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References

  1. Stoltzfus R, Dreyfuss M. Guidelines for the use of iron supplements to prevent and treat iron deficiency anemia. 1998;Washington: ILSI Press.

    Google Scholar 

  2. Zimmermann MB, Hurrell RF, CDC, Nestel P, Lynch S, Asobayire F, Adou P, Davidsson L, Cook J, Hurrell R, White K, WHO/UNICEF/UNU, DeMaeyer E, Adiels-Tegman M, Heath A, Fairweather-Tait S, Scholl T, Hercberg S, Preziosi P, Galan P, Shayeghi M, Latunde-Dada G, Oakhill J, Al. E, Qiu A, Jansen M, Sakaris A, Al. E, Gunshin H, Mackenzie B, Berger U, Al. E, McKie A, Barrow D, Latunde-Dada G, Al. E, Donovan A, Lima C, Pinkus J, Al. E, Collins J, Franck C, Kowdley K, Ghishan F, Ganz T, Nemeth E, Tuttle M, Powelson J, Al. E, Nicolas G, Chauvet C, Viatte L, Al. E, Nemeth E, Valore E, Territo M, Schiller G, Lichtenstein A, Ganz T, Knutson M, Vafa M, Haile D, Wessling-Resnick M, Skikne B, Flowers C, Cook J, Robb A, Wessling-Resnick M, Hintze K, Theil E, Clarke S, Vasanthakumar A, Anderson S, Al. E, Collins J, Umbreit J, Wang R, Li C, Xu X, Al. E, Fomon S, Medicine I of, FAO/WHO, Zimmermann M, Chaouki N, Hurrell R, Hurrell R, Moy R, Pizarro F, Yip R, Dallman P, Olivares M, Hertrampf E, Walter T, Yip R, Binkin N, Flashood L, Trowbridge F, Harvey L, Armah C, Dainty J, Al. E, Looker A, Dallman P, Carroll M, Gunter E, Johnson C, Bothwell T, Charlton R, Cook J, Finch C, Cooper E, Bundy D, Crompton D, Nesheim M, Larocque R, Casapia M, Gotuzzo E, Gyorkos T, Bungiro R, Cappello M, Stoltzfus R, Chwaya H, Tielsch J, Al. E, Atukorala T, Silva L de, Dechering W, Dassenaeike T, Perera R, Torlesse H, Hodges M, Christian P, Khatry S, West K, Champagne E, Rashid M, Cranney A, Zarkadas M, Al. E, Dube C, Rostom A, Sy R, Al. E, Cardenas V, Mulla Z, Ortiz M, Graham D, Sarker S, Davidsson L, Mahmud H, Al. E, Horton S, Ross J, Baltussen R, Knai C, Sharan M, Brabin B, Hakimi M, Pelletier D, Brabin B, Premji Z, Verhoeff F, Khan K, Wojdyla D, Say L, Gulmezoglu A, Look P Van, Lozoff B, Andraca I De, Castillo M, Smith J, Walter T, Pino P, Grantham-McGregor S, Ani C, Sachdev H, Gera T, Nestel P, Beard J, Silva A de, Atukorala S, Weerasinghe I, Ahluwalia N, Sachdev H, Gera T, Nestel P, Zimmermann M, Adou P, Torresani T, Al. E, Zimmermann M, Wegmueller R, Zeder C, Al. E, Hess S, Zimmermann M, Arnold M, Langhans W, Hurrell R, Munoz E, Rosado J, Lopez P, Furr H, Allen L, Wieringa F, Dijkhuizen M, West C, Thurnham D, Muhilal, Meer J Van der, Zimmermann M, Muthayya S, Moretti D, Kurpad A, Hurrell R, Haas J, Brownlie T, Horton S, Levin C, Brownlie T, Utermohlen V, Hinton P, Al. E, Brutsaert T, Hernandez-Cordero S, Rivera J, Al. E, Ullrich C, Wu A, Armsby C, Al. E, Mast A, Binder M, Lu Q, Al. E, Metzgeroth G, Adelberger V, Dorn-Beineke A, Al. E, Zimmermann M, Molinari L, Staubli F, Al. E, Cook J, Mei Z, Cogswell M, Parvanta I, Al. E, Finch C, Bellotti V, Stray S, Al. E, Skikne B, Flowers C, Cook J, Verhoef H, West C, Ndeto P, Burema J, Beguin Y, Kok F, Menendez C, Quinto L, Kahigwa E, Al. E, Cook J, Flowers C, Skikne B, Rimon E, Levy S, Sapir A, Al. E, Moretti D, Zimmermann M, Muthayya S, Al. E, Cook J, Boy E, Flowers C, Mdel CD, Wieringa F, Dijkhuizen M, West C, Northrop-Clewes C, Muhilal, Baillie F, Morrison A, Fergus I, Cavalli-Sforza T, Berger J, Smitasiri S, Viteri F, Cogswell M, Parvanta I, Ickes L, Yip R, Brittenham G, Siega-Riz A, Hartzema A, Turnbull C, Thorp J, McDonald T, Cogswell M, Oppenheimer S, Gera T, Sachdev H, Sazawal S, Black R, Ramsan M, Al. E, Carter J, Loolpapit M, Lema O, Tome J, Nagelkerke N, Watkins W, English M, Snow R, Tielsch J, Khatry S, Stoltzfus R, Al. E, WHO, WHO, FAO, Laxminarayan R, Mills A, Breman J, Al. E, Owen A, Owen G, Olsson K, Vaisanen M, Konar J, Bruce A, Hallberg L, Hulthen L, Milman N, Byg K, Ovesen L, Kirchhoff M, Jurgensen K, Milman N, Byg K, Ovesen L, Kirchhoff M, Jurgensen K, Zimmermann M, Winichagoon P, Gowachirapant S, Al. E, Thuy P van, Berger J, Davidsson L, Al. E, Stuijvenberg M van, Smuts C, Wolmarans P, Lombard C, Dhansay M, Zimmermann M, Zeder C, Chaouki N, Saad A, Torresani T, Hurrell R, Wegmuller R, Camara F, Zimmermann M, Adou P, Hurrell R, Hurrell R, Lynch S, Bothwell T, Al. E, Hurrell R, Bothwell T, Cook J, Force ST, Al. E, Swain J, Newman S, Hunt J, Nestel P, Nalubola R, Sivakaneshan R, Wickramasinghe A, Atukorala S, Wickramanayake T, Hertrampf E, Faber M, Kvalsvig J, Lombard C, Benade A, Initiative FF, Viteri F, Garcia-Ibanez R, Torun B, Ballot D, MacPhail A, Bothwell T, Gillooly M, Mayet F, Huo J, Sun J, Miao H, Al. E, Andag’o P, Osendarp S, Ayah R, Al. E, Bothwell T, MacPhail A, Organization WH, Safety IP on C, Fidler M, Walczyk T, Davidsson L, Al. E, Hertrampf E, Olivares M, Pizzaro F, Walter T, Perez-Exposito A, Villalpando S, Rivera J, Griffin I, Abrams S, Briend A, Solomons N, Nestel P, Briend A, Benoist B de, Al. E, Zlotkin S, Arthur P, Schauer C, Antwi K, Yeung G, Piekarz A, Welch R, House W, Beebe S, Cheng Z, Frossard E, Bucher M, Mächler F, Mozafar A, Hurrell R, Haas J, Beard J, Murray-Kolb L, Mundo A del, Felix A, Gregorio G, Genc Y, Humphries J, Lyons G, Graham R, Nestel P, Bouis H, Meenakshi J, Pfeiffer W, Hurrell R, Reddy M, Cook J, Donangelo C, Woodhouse L, King S, Al. E, Raboy V, Tuntawiroon M, Sritongkul N, Rossander-Hulten L, Al. E, Hallberg L, Brune M, Rossander L, Zimmermann M, Hurrell R, Lonnerdal B, Goto F, Yoshihara T, Shigemoto N, Toki S, Takaiwa F, Lucca P, Hurrell R, Potrykus I, Samuelsen A, Martin R, Mok D, Mok M, Nemeth E, Rivera S, Gabayan V, Al. E. Nutritional iron deficiency. Lancet (London, England); 2007;370:511–20.

    Google Scholar 

  3. Andrews NC. Disorders of iron metabolism. N Engl J Med. 1999;341:1986–95.

    Article  CAS  PubMed  Google Scholar 

  4. Clark SF. Iron deficiency anemia: diagnosis and management. Curr Opin Gastroenterol. 2009;25:122–8.

    Article  CAS  PubMed  Google Scholar 

  5. McLean E, Cogswell M, Egli I, Wojdyla D, de Benoist B. Worldwide prevalence of anaemia, WHO Vitamin and Mineral Nutrition Information System, 1993-2005. Public Health Nutr. 2009;12:444–54.

    Article  PubMed  Google Scholar 

  6. Lundström U. Iron deficiency anaemia. Gut. 1994;35:864–5.

    Article  Google Scholar 

  7. Gurusamy KS, Nagendran M, Broadhurst JF, Anker SD, Richards T. Iron therapy in anaemic adults without chronic kidney disease. Cochrane database Syst Rev 2014;CD010640.

    Google Scholar 

  8. Albaramki J, Hodson EM, Craig JC, Webster AC. Parenteral versus oral iron therapy for adults and children with chronic kidney disease. Cochrane database Syst Rev 2012;(1):CD007857.

    Google Scholar 

  9. Susantitaphong P, Alqahtani F, Jaber BL. Efficacy and safety of intravenous iron therapy for functional iron deficiency anemia in hemodialysis patients: a meta-analysis. Am J Nephrol. 2014;39:130–41.

    Article  CAS  PubMed  Google Scholar 

  10. Anker SD, Comin Colet J, Filippatos G, Willenheimer R, Dickstein K, Drexler H, Lüscher TF, Bart B, Banasiak W, Niegowska J, Kirwan B, Mori C, von Eisenhart RB, Pocock SJ, Poole-Wilson PA, Ponikowski P. Ferric carboxymaltose in patients with heart failure and iron deficiency. N Engl J Med. 2009;361:2436–48.

    Article  CAS  PubMed  Google Scholar 

  11. Ponikowski P, van Veldhuisen DJ, Comin-Colet J, Ertl G, Komajda M, Mareev V, McDonagh T, Parkhomenko A, Tavazzi L, Levesque V, Mori C, Roubert B, Filippatos G, Ruschitzka F, Anker SD. Beneficial effects of long-term intravenous iron therapy with ferric carboxymaltose in patients with symptomatic heart failure and iron deficiency. Eur Heart J. 2015;36:657–68.

    Article  CAS  PubMed  Google Scholar 

  12. Okonko DO, Mandal AKJ, Missouris CG, Poole-Wilson PA. Disordered iron homeostasis in chronic heart failure: Prevalence, predictors, and relation to anemia, exercise capacity, and survival. J Am Coll Cardiol. 2011;58:1241–51.

    Article  CAS  PubMed  Google Scholar 

  13. Jankowska EA, Von Haehling S, Anker SD, MacDougall IC, Ponikowski P. Iron deficiency and heart failure: diagnostic dilemmas and therapeutic perspectives. Eur Heart J. 2013;34:816–26.

    Article  CAS  PubMed  Google Scholar 

  14. Hughes CM, Woodside JV, McGartland C, Roberts MJ, Nicholls DP, McKeown PP. Nutritional intake and oxidative stress in chronic heart failure. Nutr Metab Cardiovasc Dis. 2012;22:376–82.

    Article  CAS  PubMed  Google Scholar 

  15. Lourenço BH, Vieira LP, Macedo A, Nakasato M, de Marucci M FN, Bocchi EA. Nutritional status and adequacy of energy and nutrient intakes among heart failure patients. Arq Bras Cardiol. 2009;93:541–8.

    Article  PubMed  Google Scholar 

  16. Hallberg L, Hulthén L. Prediction of dietary iron absorption: an algorithm for calculating absorption and bioavailability of dietary iron. Am J Clin Nutr. 2000;71:1147–60.

    CAS  PubMed  Google Scholar 

  17. González-Costello J, Comín-Colet J. Iron deficiency and anaemia in heart failure: understanding the FAIR-HF trial [Internet]. Eur J Heart Fail. 2010:1159–62.

    Google Scholar 

  18. Weber CS, Beck-Da-Silva L, Goldraich LA, Biolo A, Clausell N. Anemia in heart failure: association of hepcidin levels to iron deficiency in stable outpatients. Acta Haematol. 2013;129:55–61.

    Article  CAS  PubMed  Google Scholar 

  19. Nemeth E, Ganz T. Regulation of iron metabolism by hepcidin. Annu Rev Nutr. 2006;26:323–42.

    Article  CAS  PubMed  Google Scholar 

  20. Nicolas G, Bennoun M, Porteu A, Mativet S, Beaumont C, Grandchamp B, Sirito M, Sawadogo M, Kahn A, Vaulont S. Severe iron deficiency anemia in transgenic mice expressing liver hepcidin. Proc Natl Acad Sci. 2002;99:4596–601.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  21. Silvestri L. Inhibiting the hepcidin inhibitor for treatment of iron overload [Internet]. Blood. 2013:1068–9.

    Google Scholar 

  22. Jankowska EA, Malyszko J, Ardehali H, Koc-Zorawska E, Banasiak W, von Haehling S, Macdougall IC, Weiss G, McMurray JJV, Anker SD, Gheorghiade M, Ponikowski P. Iron status in patients with chronic heart failure. Eur Heart J. 2013;34:827–34.

    Article  CAS  PubMed  Google Scholar 

  23. Jankowska EA, Kasztura M, Sokolski M, Bronisz M, Nawrocka S, Ole kowska-Florek W, Zymli ski R, Biegus J, Siwo owski P, Banasiak W, Anker SD, Filippatos G, Cleland JGF, Ponikowski P. Iron deficiency defined as depleted iron stores accompanied by unmet cellular iron requirements identifies patients at the highest risk of death after an episode of acute heart failure. Eur Heart J. 2014;35:2468–76.

    Article  CAS  PubMed  Google Scholar 

  24. Moreno Chulilla JA, Romero Colás MS, Gutiérrez MM. Classification of anemia for gastroenterologists. World J Gastroenterol. 2009;15:4627–37.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  25. Goddard AF, James MW, McIntyre AS, Scott BB, British Society of Gastroenterology. Guidelines for the management of iron deficiency anaemia. Gut 2011;60:1309–16.

    Google Scholar 

  26. Gale E, Torrance J, Bothwell T. The quantitative estimation of total iron stores in human bone marrow. J Clin Invest; 1963;42:1076–82. American Society for Clinical Investigation.

    Google Scholar 

  27. Pasricha S-RS, Flecknoe-Brown SC, Allen KJ, Gibson PR, McMahon LP, Olynyk JK, Roger SD, Savoia HF, Tampi R, Thomson AR, Wood EM, Robinson KL. Diagnosis and management of iron deficiency anaemia: a clinical update. Med J Aust. 2010;193:525–32.

    PubMed  Google Scholar 

  28. Goodnough LT, Nemeth E, Ganz T. Detection, evaluation, and management of iron-restricted erythropoiesis. Blood. 2010;116:4754–61.

    Article  CAS  PubMed  Google Scholar 

  29. Wish JB. Assessing iron status: beyond serum ferritin and transferrin saturation. Clin J Am Soc Nephrol ; 2006;1:S4–S8. American Society of Nephrology.

    Google Scholar 

  30. Koulaouzidis A, Said E, Cottier R, Saeed AA. Soluble transferrin receptors and iron deficiency, a step beyond ferritin. a systematic review. J Gastrointestin Liver Dis. 2009;18:345–52.

    PubMed  Google Scholar 

  31. Ali MA, Luxton AW, Walker WH. Serum ferritin concentration and bone marrow iron stores: a prospective study. Can Med Assoc J ; 1978;118:945–6. Canadian Medical Association.

    Google Scholar 

  32. Ponikowski P, Voors AA, Anker SD, Bueno H, Cleland JGF, Coats AJS, Falk V, González-Juanatey JR, Harjola V-P, Jankowska EA, Jessup M, Linde C, Nihoyannopoulos P, Parissis JT, Pieske B, Riley JP, Rosano GMC, Ruilope LM, Ruschitzka F, Rutten FH, van der Meer P. 2016 ESC guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur J Heart Fail. 2016;18(8):891–975.

    Article  PubMed  Google Scholar 

  33. Jankowska EA, Rozentryt P, Witkowska A, Nowak J, Hartmann O, Ponikowska B, Borodulin-Nadzieja L, Banasiak W, Polonski L, Filippatos G, McMurray JJV, Anker SD, Ponikowski P. Iron deficiency: an ominous sign in patients with systolic chronic heart failure. Eur Heart J. 2010;31:1872–80.

    Article  CAS  PubMed  Google Scholar 

  34. Parikh A, Natarajan S, Lipsitz SR, Katz SD. Iron deficiency in community-dwelling US adults with self-reported heart failure in the National Health and Nutrition Examination Survey III: prevalence and associations with anemia and inflammation. Circ Heart Fail. 2011;4:599–606.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  35. Klip IT, Comin-Colet J, Voors AA, Ponikowski P, Enjuanes C, Banasiak W, Lok DJ, Rosentryt P, Torrens A, Polonski L, Van Veldhuisen DJ, Van Der Meer P, Jankowska EA. Iron deficiency in chronic heart failure: an international pooled analysis. Am Heart J. 2013;165:575–582.e3.

    Article  CAS  PubMed  Google Scholar 

  36. Comín-Colet J, Enjuanes C, González G, Torrens A, Cladellas M, Meroño O, Ribas N, Ruiz S, Gómez M, Verdú JM, Bruguera J. Iron deficiency is a key determinant of health-related quality of life in patients with chronic heart failure regardless of anaemia status. Eur J Heart Fail. 2013;15:1164–72.

    Article  PubMed  PubMed Central  Google Scholar 

  37. Kasner M, Aleksandrov AS, Westermann D, Lassner D, Gross M, Von Haehling S, Anker SD, Schultheiss HP, Tschöpe C. Functional iron deficiency and diastolic function in heart failure with preserved ejection fraction. Int J Cardiol. 2013;168:4652–7.

    Article  PubMed  Google Scholar 

  38. Rangel I, Gonçalves A, de Sousa C, Leite S, Campelo M, Martins E, Amorim S, Moura B, Silva Cardoso J, Maciel MJ. Iron deficiency status irrespective of anemia: a predictor of unfavorable outcome in chronic heart failure patients. Cardiology. 2014;128:320–6.

    Article  CAS  PubMed  Google Scholar 

  39. Yeo TJ, Yeo PSD, Ching-Chiew Wong R, Ong HY, Leong KTG, Jaufeerally F, Sim D, Santhanakrishnan R, Lim SL, M.Y Chan M, Chai P, Low AF, Ling LH, Ng TP, Richards AM, Lam CSP. Iron deficiency in a multi-ethnic Asian population with and without heart failure: prevalence, clinical correlates, functional significance and prognosis. Eur J Heart Fail. 2014;16:1125–32.

    Article  CAS  PubMed  Google Scholar 

  40. Schou M, Bosselmann H, Gaborit F, Iversen K, Goetze JP, Soletomas G, Rasmussen J, Kistorp C, Kober L, Gustafsson F, Tonder N. Iron de fi ciency : prevalence and relation to cardiovascular biomarkers in heart failure outpatients. Int J Cardiol. 2015;195:143–8.

    Article  PubMed  Google Scholar 

  41. Ebner N, Jankowska EA, Ponikowski P, Lainscak M, Elsner S, Sliziuk V, Steinbeck L, Kube J, Bekfani T, Scherbakov N, Valentova M, Sandek A, Doehner W, Springer J, Anker SD, Von Haehling S. The impact of iron deficiency and anaemia on exercise capacity and outcomes in patients with chronic heart failure. Results from the studies investigating co-morbidities aggravating heart failure. Int J Cardiol. 2016;205:6–12.

    Article  PubMed  Google Scholar 

  42. Núñez J, Domínguez E, Ramón JM, Núñez E, Sanchis J, Santas E, Heredia R, González J, Miñana G, López L, Chorro FJ, Palau P. Iron deficiency and functional capacity in patients with advanced heart failure with preserved ejection fraction. Int J Cardiol. 2016;207:365–7.

    Article  PubMed  Google Scholar 

  43. Cohen-Solal A, Damy T, Terbah M, Kerebel S, Baguet JP, Hanon O, Zannad F, Laperche T, Leclercq C, Concas V, Duvillie L, Darne B, Anker S, Mebazaa A. High prevalence of iron deficiency in patients with acute decompensated heart failure. Eur J Heart Fail. 2014;16:984–91.

    Article  CAS  PubMed  Google Scholar 

  44. de Silva R, Rigby AS, Witte KK, Nikitin NP, Tin L, Goode K, Bhandari S, Clark AL, Cleland JGF. Anemia, renal dysfunction, and their interaction in patients with chronic heart failure. Am J Cardiol. 2006;98:391–8.

    Article  PubMed  Google Scholar 

  45. Nanas JN, Matsouka C, Karageorgopoulos D, Leonti A, Tsolakis E, Drakos SG, Tsagalou EP, Maroulidis GD, Alexopoulos GP, Kanakakis JE, Anastasiou-Nana MI. Etiology of anemia in patients with advanced heart failure. J Am Coll Cardiol. 2006;48:2485–9.

    Article  PubMed  Google Scholar 

  46. Jankowska EA, Rozentryt P, Witkowska A, Nowak J, Hartmann O, Ponikowska B, Borodulin-Nadzieja L, Von Haehling S, Doehner W, Banasiak W, Polonski L, Filippatos G, Anker SD, Ponikowski P. Iron deficiency predicts impaired exercise capacity in patients with systolic chronic heart failure. J Card Fail. 2011;17:899–906.

    Article  CAS  PubMed  Google Scholar 

  47. Enjuanes C, Klip IT, Bruguera J, Cladellas M, Ponikowski P, Banasiak W, van Veldhuisen DJ, van der Meer P, Jankowska EA, Comín-Colet J. Iron deficiency and health-related quality of life in chronic heart failure: results from a multicenter European study. Int J Cardiol. 2014;174:268–75.

    Article  PubMed  Google Scholar 

  48. Aung N, Ling HZ, Cheng AS, Aggarwal S, Flint J, Mendonca M, Rashid M, Kang S, Weissert S, Coats CJ, Richards T, Thomas M, Woldman S, Okonko DO. Expansion of the red cell distribution width and evolving iron deficiency as predictors of poor outcome in chronic heart failure. Int J Cardiol. 2013;168:1997–2002.

    Article  PubMed  Google Scholar 

  49. Van Wyck DB, Roppolo M, Martinez CO, Mazey RM, Mcmurray S. A randomized, controlled trial comparing IV iron sucrose to oral iron in anemic patients with nondialysis-dependent CKD. Kidney Int. 2005;68:2846–56.

    Article  CAS  PubMed  Google Scholar 

  50. Macdougall IC, Bock AH, Carrera F, Eckardt K-U, Gaillard C, Van Wyck D, Roubert B, Nolen JG, Roger SD. FIND-CKD: a randomized trial of intravenous ferric carboxymaltose versus oral iron in patients with chronic kidney disease and iron deficiency anaemia. Nephrol Dial Transplant. 2014;29:2075–84.

    Article  PubMed  PubMed Central  Google Scholar 

  51. Charytan C, Qunibi W, Bailie GR. Comparison of intravenous iron sucrose to oral iron in the treatment of anemic patients with chronic kidney disease not on dialysis. Nephron Clin Pract. 2005;100:c55–62.

    Article  CAS  PubMed  Google Scholar 

  52. Agarwal R, Rizkala AR, Bastani B, Kaskas MO, Leehey DJ, Besarab A. A randomized controlled trial of oral versus intravenous iron in chronic kidney disease. Am J Nephrol. 2006;26:445–54.

    Article  CAS  PubMed  Google Scholar 

  53. Aggarwal HK, Nand N, Singh S, Singh M, Hemant KG. Comparison of oral versus intravenous iron therapy in predialysis patients of chronic renal failure receiving recombinant human erythropoietin. J Assoc Physicians India. 2003;51:170–4.

    CAS  PubMed  Google Scholar 

  54. Spinowitz BS, Kausz AT, Baptista J, Noble SD, Sothinathan R, Bernardo M V, Brenner L, Pereira BJG. Ferumoxytol for treating iron deficiency anemia in CKD. J Am Soc Nephrol; 2008;19:1599–605. 2008/06/06 ed.

    Google Scholar 

  55. Stoves J, Inglis H, Newstead CG. A randomized study of oral vs intravenous iron supplementation in patients with progressive renal insufficiency treated with erythropoietin. Nephrol Dial Transplant. 2001;16:967–74.

    Article  CAS  PubMed  Google Scholar 

  56. Breymann C, Gliga F, Bejenariu C, Strizhova N. Comparative efficacy and safety of intravenous ferric carboxymaltose in the treatment of postpartum iron deficiency anemia. Int J Gynaecol Obstet. 2008;101:67–73.

    Article  CAS  PubMed  Google Scholar 

  57. Seid MH, Derman RJ, Baker JB, Banach W, Goldberg C, Rogers R. Ferric carboxymaltose injection in the treatment of postpartum iron deficiency anemia: a randomized controlled clinical trial. Am J Obstet Gynecol. 2008;199:435.e1–e435.e7.

    Article  Google Scholar 

  58. Schröder O, Mickisch O, Seidler U, de Weerth A, Dignass AU, Herfarth H, Reinshagen M, Schreiber S, Junge U, Schrott M, Stein J. Intravenous iron sucrose versus oral iron supplementation for the treatment of iron deficiency anemia in patients with inflammatory bowel disease – a randomized, controlled, open-label, multicenter study. Am J Gastroenterol. 2005;100:2503–9.

    Article  PubMed  Google Scholar 

  59. Niehaus ED, Malhotra R, Cocca-Spofford D, Semigran M, Lewis GD. Repletion of iron stores with the use of oral iron supplementation in patients with systolic heart failure. J Card Fail; 2015;21:694–7.

    Google Scholar 

  60. Heath CW, Strauss MB, Castle WB. Quantitative aspects of rion deficiency in hypochromic anemia: (the parenteral administration of iron). J Clin Invest. 1932;11:1293–312.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  61. Goetsch AT, Moore CV, Minnich V. Observations on the effect of massive doses of iron given intravenously to patients with hypochromic anemia. J Lab Clin Med. 1946;31:466.

    CAS  PubMed  Google Scholar 

  62. Evans RW, Rafique R, Zarea A, Rapisarda C, Cammack R, Evans PJ, Porter JB, Hider RC. Nature of non-transferrin-bound iron: studies on iron citrate complexes and thalassemic sera. JBIC J Biol Inorg Chem. 2007;13:57–74.

    Article  PubMed  Google Scholar 

  63. Macdougall IC. Evolution of iv iron compounds over the last century. J Ren Care. 2009;35(Suppl 2):8–13.

    Article  PubMed  Google Scholar 

  64. Bolger AP, Bartlett FR, Penston HS, O’Leary J, Pollock N, Kaprielian R, Chapman CM. Intravenous iron alone for the treatment of anemia in patients with chronic heart failure. J Am Coll Cardiol. 2006;48:1225–7.

    Article  CAS  PubMed  Google Scholar 

  65. Toblli JE, Lombraña A, Duarte P, Di Gennaro F. Intravenous iron reduces NT-Pro-brain natriuretic peptide in anemic patients with chronic heart failure and renal insufficiency. J Am Coll Cardiol. 2007;50:1657–65.

    Article  CAS  PubMed  Google Scholar 

  66. Okonko DO, Grzeslo A, Witkowski T, Mandal AKJ, Slater RM, Roughton M, Foldes G, Thum T, Majda J, Banasiak W, Missouris CG, Poole-Wilson PA, Anker SD, Ponikowski P. Effect of intravenous iron sucrose on exercise tolerance in anemic and nonanemic patients with symptomatic chronic heart failure and iron deficiency. J Am Coll Cardiol. 2008;51:103–12.

    Article  CAS  PubMed  Google Scholar 

  67. Usmanov RI, Zueva EB, Silverberg DS, Shaked M. Intravenous iron without erythropoietin for the treatment of iron deficiency anemia in patients with moderate to severe congestive heart failure and chronic kidney insufficiency. J Nephrol. 2008;21:236–42.

    CAS  PubMed  Google Scholar 

  68. Terrovitis JV, Kaldara E, Ntalianis A, Sventzouri S, Kapelios C, Barbarousi D, Matsouka C, Nanas JN. Intravenous iron alone is equally effective with the combination of iron and erythropoietin for the treatment of iron-deficiency anemia in advanced heart failure. J Am Coll Cardiol. 2012;60:2255–6.

    Article  CAS  PubMed  Google Scholar 

  69. Beck-Da-Silva L, Piardi D, Soder S, Rohde LE, Pereira-Barretto AC, De Albuquerque D, Bocchi E, Vilas-Boas F, Moura LZ, Montera MW, Rassi S, Clausell N. IRON-HF study: a randomized trial to assess the effects of iron in heart failure patients with anemia. Int J Cardiol. 2013;168:3439–42.

    Article  PubMed  Google Scholar 

  70. Toblli JE, Di Gennaro F, Rivas C. Changes in echocardiographic parameters in iron deficiency patients with heart failure and chronic kidney disease treated with intravenous iron. Heart Lung Circ ; 2015;24:686–95. Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ).

    Google Scholar 

  71. Gaber R, Kotb NA, Ghazy M, Nagy HM, Salama M, Elhendy A. Tissue doppler and strain rate imaging detect improvement of myocardial function in iron deficient patients with congestive heart failure after iron replacement therapy. Echocardiography. 2012;29:13–8.

    Article  PubMed  Google Scholar 

  72. Kaminsky BM, Pogue KT, Hanigan S, Koelling TM, Dorsch MP. Effects of total dose infusion of iron intravenously in patients with acute heart failure and anemia (Hemoglobin &lt; 13 g/dl). Am J Cardiol. 2016;117:1942–6.

    Article  CAS  PubMed  Google Scholar 

  73. Hildebrandt PR, Bruun NE, Nielsen OW, Pantev E, Shiva F, Videbæk L, Wikström G, Thomsen LL. Effects of administration of iron isomaltoside 1000 in patients with chronic heart failure. A pilot study. Transfus Altern Transfus Med; 2010;11:131–7.

    Google Scholar 

  74. Reed BN, Blair EA, Thudium EM, Waters SB, Sueta CA, Jensen BC, Rodgers JE. Effects of an accelerated intravenous iron regimen in hospitalized patients with advanced heart failure and iron deficiency. Pharmacotherapy. 2015;35:64–71.

    Article  CAS  PubMed  Google Scholar 

  75. Ganzoni AM. Intravenous iron-dextran: therapeutic and experimental possibilities. Schweiz Med Wochenschr. 1970;100:301–3.

    CAS  PubMed  Google Scholar 

  76. Anker SD, Colet JC, Filippatos G, Willenheimer R, Dickstein K, Drexler H, Lüscher TF, Mori C, von Eisenhart Rothe B, Pocock S, Poole-Wilson PA, Ponikowski P, FAIR-HF committees and investigators. Rationale and design of Ferinject assessment in patients with IRon deficiency and chronic Heart Failure (FAIR-HF) study: a randomized, placebo-controlled study of intravenous iron supplementation in patients with and without anaemia. Eur J Heart Fail 2009;11:1084–91.

    Google Scholar 

  77. Filippatos G, Farmakis D, Colet JC, Dickstein K, Lüscher TF, Willenheimer R, Parissis J, Gaudesius G, Mori C, Rothe BVE, Greenlaw N, Ford I, Ponikowski P, Anker SD. Intravenous ferric carboxymaltose in iron-deficient chronic heart failure patients with and without anaemia: a subanalysis of the FAIR-HF trial. Eur J Heart Fail. 2013;15:1267–76.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  78. Ponikowski P, Veldhuisen DJ Van, Comin-colet J, Ertl G, Komajda M, Mareev V, Parkhomenko A, Tavazzi L. Rationale and design of the CONFIRM-HF study : a to assess the effects of intravenous ferric carboxymaltose on functional capacity in patients with chronic heart failure and iron deficiency. ESC Hear Fail 2014;1:52–8.

    Google Scholar 

  79. Kapoor M, Schleinitz MD, Gemignani A, Wu W-C. Outcomes of patients with chronic heart failure and iron deficiency treated with intravenous iron: a meta-analysis. Cardiovasc Hematol Disord Drug Targets. 2013;13:35–44.

    Article  CAS  PubMed  Google Scholar 

  80. Avni T, Leibovici L, Gafter-Gvili A. Iron supplementation for the treatment of chronic heart failure and iron deficiency: systematic review and meta-analysis. Eur J Heart Fail. 2012;14:423–9.

    Article  CAS  PubMed  Google Scholar 

  81. Desai A, Lewis E, Solomon S, McMurray JJV, Pfeffer M. Impact of erythropoiesis-stimulating agents on morbidity and mortality in patients with heart failure: an updated, post-TREAT meta-analysis. Eur J Heart Fail. 2010;12:936–42.

    Article  PubMed  Google Scholar 

  82. Qian C, Wei B, Ding J, Wu H, Wang Y. The efficacy and safety of iron supplementation in patients with heart failure and iron deficiency: a systematic review and meta-analysis. Can J Cardiol; 2016;32:151–9. Canadian Cardiovascular Society.

    Google Scholar 

  83. Jankowska EA, Tkaczyszyn M, Suchocki T, Drozd M, von Haehling S, Doehner W, Banasiak W, Filippatos G, Anker SD, Ponikowski P. Effects of intravenous iron therapy in iron-deficient patients with systolic heart failure: a meta-analysis of randomized controlled trials. Eur J Heart Fail. 2016;18(7):786–95.

    Article  CAS  PubMed  Google Scholar 

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Acknowledgement:

The preparation of the manuscript was supported by the National Science Centre (Poland) grant allocated on the basis of the decision number DEC-2012/05/E/NZ5/00590.

Conflict of Interest:

Wroclaw Medical University received an unrestricted grant from Vifor Pharma. E.A.J. reports grants and personal fees from Vifor Pharma and personal fees from Fresenius. M.D. reports personal fees from Fresenius. P.P. reports personal fees from Vifor Pharma and AMGEN.

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Authors and Affiliations

  1. Department of Heart Diseases, Wroclaw Medical University, Wroclaw, Poland

    Ewa A. Jankowska MD, PhD, FESC, Marcin Drozd MD & Piotr Ponikowski MD, PhD, FESC

  2. Cardiology Department, Centre for Heart Diseases, Military Hospital, Wroclaw, Poland

    Ewa A. Jankowska MD, PhD, FESC, Marcin Drozd MD & Piotr Ponikowski MD, PhD, FESC

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  1. Ewa A. Jankowska MD, PhD, FESC
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  2. Marcin Drozd MD
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  3. Piotr Ponikowski MD, PhD, FESC
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Correspondence to Ewa A. Jankowska MD, PhD, FESC .

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  1. Emergency Clinical Hospital of Bucharest, UMF Carol Davila – Bucharest Emergency Clinical Hospital of Bucharest, Bucharest, Romania

    Maria Dorobanţu

  2. Department of Cardiology, University Heart Center Department of Cardiology, Zürich, Switzerland

    Frank Ruschitzka

  3. Section of Cardiovascular Diseases, University of Brescia Section of Cardiovascular Diseases, Brescia, Italy

    Marco Metra

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Jankowska, E.A., Drozd, M., Ponikowski, P. (2016). Iron Deficiency in Heart Failure. In: Dorobanţu, M., Ruschitzka, F., Metra, M. (eds) Current Approach to Heart Failure. Springer, Cham. https://doi.org/10.1007/978-3-319-45237-1_25

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