Fluctuation of Heart Failure with Preserved Ejection Fraction During the Course of Cardiorenal Anemia Syndrome: A Case Report

Heart failure (HF) with preserved ejection function (HFpEF) has a high prevalence in older adults. HF in the elderly tends to be complicated by renal failure and anemia, known as cardio-renal anemia syndrome (CRAS), with each pathology adversely affecting the other, leading to a negative spiral. The temporal evolution from the onset of HFpEF in CRAS is not well understood. We experienced an elderly case in which the initial onset of CRAS was followed by repeated exacerbations with HFpEF. Multiple medications, including a sodium-glucose cotransporter-2 inhibitor and an angiotensin receptor neprilysin inhibitor, were effective in conjunction with extensive cardiac rehabilitation. Our case highlights the difficulty of treating HFpEF with CRAS.