Fig. 1

Cardio-renal-anemia (CRA) syndrome. CKD-induced anemia produces hypoxic condition which leads to an increase in oxidative stress. CKD also facilitates chronic inflammation and hypoxia in renal tissue, activating systemic, and local RAS. These changes trigger to aggravate cardiac hypertrophy and reduce cardiac output, which in turn decreases organ perfusion including the kidney. With such a mechanism, renal anemia in CKD creates a vicious circle in conjunction with CVD/HF, so-called the CRA syndrome, which may eventually result in poor patients’ prognosis. CVD cerebrovascular disease, LVH left ventricular hypertrophy, HF heart failure. Quoted from reference # 23,24