Features:
(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
