Anemia After Kidney Transplantation Is Not Completely Explained by Reduced Kidney Function

Chadban, Steven J.; Baines, Laura; Polkinghorne, Kevan R.; Jefferys, Andrew; Dogra, Sharan; Kanganas, C; Irish, Ashley; Eris, Josette; Walker, Rowan G.

doi:10.1053/j.ajkd.2006.11.034

Cited by 64 publications

(42 citation statements)

References 20 publications

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“…PTA is 10 times higher than that in CKD stage-matched predialysis patients [262]. As renal function deteriorates, the prevalence of anemia in renal transplant recipients increases compared with that in non-transplant patients.…”

Section: Rationalementioning

confidence: 91%

See 1 more Smart Citation

2015 Japanese Society for Dialysis Therapy: Guidelines for Renal Anemia in Chronic Kidney Disease

Yamamoto¹,

et al. 2017

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Section: Rationalementioning

confidence: 91%

“…In contrast, late PTA is detected at high rates of 30-40% in renal transplant recipients [262], and it continues during the post-transplant course. The prevalence of PTA shows no significant difference between deceasedand living-donor renal transplantations [250,252] and negligible difference between genders.…”

Section: Rationalementioning

confidence: 94%

2015 Japanese Society for Dialysis Therapy: Guidelines for Renal Anemia in Chronic Kidney Disease

Yamamoto¹,

et al. 2017

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“…Although this is not surprising in itself, the degree of anemia that occurs seems to be worse for any given degree of renal dysfunction compared with native kidney disease. For any given creatinine clearance, hemoglobin concentrations are lower in KTR compared with patients with native CKD, and the prevalence of anemia is nearly 10-fold greater in KTR compared with patients with CKD in any stratum of creatinine clearance (10). It has further been emphasized recently that renal transplant function alone can explain only part of the observed rate of anemia in these patients and that endogenous EPO levels predict anemia independent of transplant function (20).…”

Section: Causes and Correlatesmentioning

confidence: 98%

Pottransplantation Anemia

Winkelmayer

Chandraker²

2008

Clinical Journal of the American Society of Nephrology

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In recent years, there has been an increasing interest in studying the anemia that occurs after kidney transplantation. Although many of the guidelines for the treatment of kidney transplant patients, including those for anemia, are extrapolated from recommendations for patients with chronic kidney disease, there are important differences in the cause of and response to anemia in kidney transplant recipients. In addition to the correlation of anemia with kidney function as in native renal disease, many other factors are associated with the development of anemia after transplantation, including the use of medications and the inflammation/immune response. Given the lack of large, well-designed, prospective studies, the consequences of anemia, the response to treatment, and the cost-effectiveness of treatment in the posttransplantation setting are also poorly understood.Clin J Am Soc Nephrol 3: S49 -S55, 2008S49 -S55, . doi: 10.2215 A lthough anemia has been investigated with great interest and intensity in patients with chronic kidney disease (CKD), including the dialysis population, studies of the prevalence and clinical relevance of posttransplantation anemia (PTA) were scarce until a few years ago. One could argue that patients with a functioning kidney transplant are similar to patients with chronic native renal insufficiency (not on dialysis) and that evidence from the CKD population could be extrapolated to these kidney transplant recipients (KTR) (1). There are, however, at least three important reasons that such an extrapolation may not be legitimate: The presence of immunosuppressant agents and other transplant-related medications, the altered inflammatory milieu, and the history of prolonged maintenance dialysis therapy in most KTR. The altered inflammatory milieu is due to the systemic immune response to the presence of alloantigen, leading to a proinflammatory state that increases erythropoietin (EPO) resistance. Inadequate dialysis and activation of cytokines by dialysis membranes have also been shown to cause EPO resistance, but whether these factors have long-term consequences that carry over after transplantation are unknown. These and other factors may confound the validity of extrapolating scientific findings and clinical experience from the CKD (not on dialysis) population. Thus, it seems essential to establish evidence directly from the KTR population rather than through inference from patients with CKD. This article provides a critical review of the evidence on PTA. Course of Anemia after TransplantationTwo major developments have influenced the degree of anemia in patients with renal failure at the time of transplantation. The first is the widespread use of EPO for dialysis patients and patients with CKD. This has had the effect of reducing the degree of anemia in potential transplant recipients and decreased the likelihood of immunologic sensitization in patients as a result of the decreased need for blood transfusions before transplantation. Although decreasing the number of blood transfus...

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“…The belief that enough erythropoietin production with new allograft will resolve any degree of anemia in patients with CKD is not always fully realized (49). There can be many reasons for this phenomenon.…”

Section: Anemiamentioning

confidence: 99%

“…Since then there have been multiple attempts at re-defining anemia. Dependent on cut-off level of hemoglobin used for defining anemia, prevalence in post-transplant population varies roughly between 10% and 40% (49)(50)(51)(52)(53). Anemia is associated with worse patient and graft survival, higher rates of acute rejection and may further exaggerate left ventricular hypertrophy which is associated with higher cardiovascular mortality.…”

Section: Anemiamentioning

confidence: 99%