UNTREATED ANEMIA ASSOCIATED WITH INCREASED RISK OF
MORTALITY AND MORBIDITY IN CHRONICALLY ILL PATIENTS
-- More Aggressive Anemia Identification and Treatment Needed to Improve Outcomes --
Nissenson et al. Anemia: Not Just an Innocent Bystander?
Arch Intern Med. 2003; 163: 1400-1404.
MILWAUKEE, WI, June 23, 2003 -- Anemia is associated with increased risk of mortality and morbidity and has an independent impact on quality of life in chronically ill patients, according to a review article published today in the Archives of Internal Medicine, a journal of the American Medical Association (AMA). According to the article, anemia occurs often and yet is frequently unrecognized and under-treated in patients with chronic kidney disease, cancer, cardiovascular disease, rheumatoid arthritis, inflammatory bowel disease and AIDS.
The article's retrospective analysis revealed that the condition is common, with over 3.4 million Americans reporting that they are anemic. Among the general population, the most frequently affected are women, African Americans, the elderly, and those with low income. In patients with chronic diseases, the prevalence of anemia is high and the consequences can be devastating. Nearly 100 percent of chronic kidney disease patients have anemia and as many as 25 percent of congestive heart failure patients, rheumatoid arthritis patients, and cancer patients have anemia. The analysis showed that, independent of the underlying disease, anemia is associated with increased mortality in chronic kidney disease, congestive heart failure and acute myocardial infarction patients; increased morbidity in chronic kidney disease, congestive heart failure and cancer radiotherapy patients; and decreased quality of life in chronic kidney disease and cancer patients.
"Apart from the serious health risks many chronic diseases pose, when patients also have anemia, their risk of more serious illness and death greatly increases," said Dr. Allen Nissenson, professor of medicine and the director of the dialysis program at the David Geffen School of Medicine at the University of California at Los Angeles, president of the National Anemia Action Council (NAAC) and one of the article's authors.
"While the data reflect the seriousness of anemia, there is good news as well. Our analysis showed that management of anemia, independent of other risk factors, improves morbidity and possibly even mortality rates, along with patient quality of life," said Dr. Lawrence T. Goodnough, professor of medicine, pathology and immunology at Washington University School of Medicine, vice president and president-elect of the National Anemia Action Council (NAAC) and one of the article's authors. "Health professionals need to more aggressively diagnose and treat anemia."
More Aggressive Treatment Guidelines Needed
In the article, Drs. Nissenson and Goodnough call for a structured public and professional dialogue and educational approach that addresses anemia as a serious public health condition that warrants high-quality care to achieve optimal health outcomes. The authors advocate new guidelines with more aggressive approaches to diagnosing and treating anemia.
"Treatment of anemia associated with serious diseases tends to focus first on addressing the underlying disease. But if anemia persists or symptoms worsen, treatment of the anemia itself is vital to help prevent the development of severe, possibly life-threatening complications, improve patient health and enhance quality of life, noted Dr. Nissenson. "Anemia is often easily corrected with available medications that have been proven to be very safe and effective."
Anemia is a Serious Disease
Anemia is characterized by a decrease in the body's total number of red blood cells (RBCs). RBCs contain hemoglobin (Hb), a red, iron-rich protein that carries oxygen from the lungs to all of the body's tissues. Oxygen provides the energy the body needs to support its normal activities. Hemoglobin is easily measured through a simple blood test at a doctor's office.
The production of RBCs is stimulated by the hormone erythropoietin, which is produced in the kidneys. Serious diseases, such as chronic kidney disease, cancer and AIDS (and the treatments for some of these diseases) can damage the kidneys, resulting in decreased RBC production. In chronically ill patients, anemia has been shown to increase the risk of hospitalization and death; however, researchers have also shown that the treatment of anemia can improve patient health and quality of life.
Historically, health care professionals have viewed anemia as an abnormal laboratory value rather than as a serious condition that impacts mortality, morbidity and quality of life. The research, however, indicates that anemia is far from being an innocent bystander and that it can be effectively treated.
NAAC: Created to Raise Awareness of Consequences of Anemia
Drs. Nissenson and Goodnough are the founding co-chairs of the National Anemia Action Council (NAAC). NAAC is dedicated to raising awareness among health care professionals and the public of the prevalence, symptoms, and the consequences of the under-treatment of anemia. First convened in November 2000, NAAC is a nonprofit organization comprised of more than 20 leading physicians who are experts in identifying and treating anemia. Their specialties include hematology, nephrology, oncology, cardiology, critical care, rheumatology, gastroenterology, surgery and internal medicine. More information about NAAC is available on the Web at www.anemia.org.