Prevalence, Clinical Associations, and Outcomes of Cardiorenal Anemia Syndrome Among Patients With Heart Failure Attending a Tertiary Hospital in Dodoma, Tanzania: A Prospective Observational Cohort Study

Background and Aims Cardiorenal anemia syndrome (CRAS) is a common complication in heart failure (HF), often leading to unfavorable outcomes. Despite clinical significance, the published data are scarce. This study assessed prevalence, clinical associations and outcomes of CRAS among patients with HF attending the Benjamin Mkapa Hospital in Dodoma. Methods A prospective observational cohort study was carried out at cardiology clinic between August 2023 and April 2024. Adult patients aged ≥ 18 years confirmed with chronic heart failure were recruited by convenience (non‐probability) sampling. Age, sex, cigarettes smoking, dyslipidemia, obesity, New York Heart Association (NYHA) functional classification, hypertension, diabetes mellitus and iron deficiency were included as predictor variables. The primary outcome was CRAS and termed as exposed. All‐cause mortality, HF rehospitalisation, chronic kidney disease (CKD) progression and progressive anemia were secondary outcomes. Data were summarized by descriptive and inferential methods. Logistic regression was used to establish the clinical associations whereas, Cox proportional hazards regression was used to establish association of CRAS and secondary outcomes. A two‐tailed p ‐value ≤ 0.05 noted as statistical significance. Results This study involved 268 patients with a median age of 56.5 (IQR 18–92) years, 57.5% (154/268) were females. Prevalence of CRAS was 41.8% (112/268). Obesity (AOR 1.77; 95% CI, 1.02–3.06; p = 0.042), iron deficiency (AOR 2.36; 95% CI, 1.36–4.13; p = 0.002), NYHA category (class III/IV) (AOR 4.11; 95% CI, 2.35–7.16; p = 0.001) and diabetes mellitus (AOR 1.59; 95% CI, 1.03–2.70; p = 0.047) were clinically associated with unfavorable outcomes of CRAS. All‐cause mortality was high in CRAS (HR 1.96; 95% CI, 1.30–3.01; p = 0.001). Furthermore, CKD progression and progressive anemia were comparably similar to both cohorts (56.3% vs. 48.1%, p = 0.116) and (53.6% vs. 47.4%, p = 0.193), respectively. Conclusion The study showed that CRAS is highly prevalent and is associated with increased risk for all‐cause mortality. Obesity, iron deficiency, advanced NYHA functional stages and diabetes mellitus warrant special attention. This study was a single‐centered therefore, we propose a large multicentre study for generalizability.