Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Cardiol. May 26, 2023; 15(5): 273-283
Published online May 26, 2023. doi: 10.4330/wjc.v15.i5.273
Impact of erythropoietin therapy on cardiorenal syndrome: A systematic review with meta-analysis
Rubal Bhangal, Ivan Cancarevic, Mahmoud Nassar, Zaryab Umar
Rubal Bhangal, Ivan Cancarevic, Zaryab Umar, Department of Internal Medicine, Icahn School of Medicine at Mount Sinai/NYC Health+Hospitals Queens, New York, NY 11432, United States
Mahmoud Nassar, Department of Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, NY 10029, United States
Mahmoud Nassar, Department of Internal Medicine, NYC Health+Hospital Queens, New York, NY 11432, United States
Author contributions: All author contributed equally; All authors have read and approved the final version.
Conflict-of-interest statement: The authors have no conflicts of interest to declare.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: Mahmoud Nassar, MD, MSc, PhD, Doctor, Department of Internal Medicine, NYC Health+Hospital Queens, New York, NY 11432, United States.
Received: December 19, 2022
Peer-review started: December 19, 2022
First decision: February 8, 2023
Revised: March 24, 2023
Accepted: April 4, 2023
Article in press: April 4, 2023
Published online: May 26, 2023

Heart and kidney dysfunction frequently coexist in patients with acute heart failure due to the overlap between these two organ systems. Cardiorenal syndrome (CRS) results from pathology occurring in the heart and kidneys along with the consequences of dysfunction in one organ contributing to dysfunction in the other and vice versa.


To evaluate the use of erythropoietin (EPO) in patients with CRS and its effects on hemoglobin (Hb), major cardiovascular (CV) events, and hospitalization rates.


On February 24, 2022, searches were conducted using PubMed, MEDLINE, and EMBASE, and 148 articles were identified. A total of nine studies were considered in this systematic review. We assessed the included articles based on the National Heart, Lung, and Blood Institute quality assessment tools for controlled intervention and observational cohort or cross-sectional studies. An assessment of bias risk was conducted on the chosen studies, and data relevant to our review was extracted.


The systematic review of these studies concluded that most existing literature indicates that EPO improves baseline Hb levels and decreases myocardial remodeling and left ventricular dysfunction without reducing CV mortality. In addition, the effect of EPO on the hospitalization rate of patients with CRS needs to be further studied since this relationship is unknown. Future studies, such as randomized controlled clinical trials and prospective cohort studies, should be conducted to enhance the literature on the potential of EPO therapy in patients with CRS.


Our systematic review suggests that EPO therapy may have a significant role in managing CRS. The review highlights the potential benefits of EPO in improving baseline Hb levels, reducing the risk of major CV events, improving cardiac remodeling, myocardial function, New York Heart Association class, and B-type natriuretic peptide levels. However, the effect of EPO treatment on hospitalization remains unclear and needs further exploration.

Keywords: Cardiorenal syndrome, Anemia, Cardiovascular disease, End-stage renal disease, Erythropoietin, Congestive heart failure

Core Tip: Erythropoietin improves baseline hemoglobin levels and decreases the risk of major cardiovascular.