Anemia following renal transplantation

Fujiwara, Tazuko; Sakagami, K; Matsuno, T.; Tanaka, Noriaki

doi:10.1016/s0041-1345(98)00914-2

Cited by 40 publications

(29 citation statements)

References 5 publications

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“…The current study is the largest one evaluating PTA in US KTR. Other studies have found a similar prevalence of PTA, namely between 20 and 39.7% (17)(18)(19)(20)(21). The recent study by Mix et al (21) found that the prevalence of anemia (HCT Ͻ 36) was 76% at transplantation and fell to 21% 1 yr posttransplant.…”

Section: Discussionmentioning

confidence: 71%

“…Contrary to the ample data available regarding anemia in the ESRD population, much less is known about the epidemiology of PTA, and only few studies have systematically investigated this issue (17)(18)(19)(20)(21). Although these studies have contributed to our understanding of the prevalence of PTA, most of them did not systematically collect information on important prescription drug classes that are possibly associated with anemia, did not conduct rigorously controlled multivariate analyses, or were limited by small sample size for such analyses.…”

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confidence: 99%

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Pharmacoepidemiology of Anemia in Kidney Transplant Recipients

Winkelmayer

Kewalramani

Rutstein

et al. 2004

Journal of the American Society of Nephrology

127

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Abstract. Anemia has long been known to be a complication of end-stage renal disease (ESRD), and it has been linked to cardiovascular morbidity and mortality. Although kidney transplant recipients (KTR) are prone to experiencing cardiovascular outcomes, little is known about the epidemiology of anemia in this population. With few exceptions, studies to date have not fully evaluated the associations between posttransplant anemia (PTA) and medications commonly used in KTR, particularly immunosuppressant drugs, angiotensin-converting enzyme inhibitors (ACEI) and angiotensin II receptor blockers (ARB). The authors aimed to specifically investigate possible associations between these drugs and PTA. Detailed medical information was retrospectively collected on 374 consecutive KTR from our transplant clinic. Univariate/multivariate linear regression models were used to test for associations between hematocrit (HCT) and other covariates, and logistic regression models were used to detect independent predictors of PTA, defined as HCT Ͻ33%. The mean time since transplantation was 7.7 yr, and mean creatinine was 2.2 mg/dl. The prevalence of PTA was 28.6%. Ten percent of all patients were on erythropoietin therapy, but only 41.6% of patients whose HCT was Ͻ30 received this treatment. From multivariate analyses, the authors found that female gender and lower renal function were associated with lower HCT (both P Ͻ 0.001). Patients on ACEI had significantly lower HCT (P ϭ 0.005) compared with patients without such treatment. In addition, a significant curvilinear dose-response relationship was found between ACEI dose and HCT. Among the immunosuppressant drugs, mycophenolate mofetil (P ϭ 0.05) and tacrolimus (P ϭ 0.02) were associated with a lower HCT. The authors conclude that PTA is prevalent and undertreated in KTR. Several medications that are possibly modifiable correlates of PTR deserve further study.Anemia, as a complication of end-stage renal disease (ESRD) is well studied (1). Reports indicate that anemia in this patient population is associated with numerous morbidities, including cardiovascular complications such as cardiac enlargement, left ventricular hypertrophy, congestive heart failure, and angina (2-9). Furthermore, effective treatment of anemia has been demonstrated to decrease morbidity and improve survival (10 -16). The known effect of anemia on cardiovascular disease in the ESRD population would suggest that anemia may be one of the major factors that explains the burden of cardiovascular disease in the kidney transplant recipient (KTR) population. Systematic investigation into the prevalence of posttransplant anemia (PTA) is therefore of critical importance.Contrary to the ample data available regarding anemia in the ESRD population, much less is known about the epidemiology of PTA, and only few studies have systematically investigated this issue (17-21). Although these studies have contributed to our understanding of the prevalence of PTA, most of them did not systematically collect information on importa...

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Section: Discussionmentioning

confidence: 71%

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confidence: 99%

Pharmacoepidemiology of Anemia in Kidney Transplant Recipients

Winkelmayer

Kewalramani

Rutstein

et al. 2004

Journal of the American Society of Nephrology

127

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“…Although the reported prevalence of PTA shows great variations in different studies (2)(3)(4)(5)(6), the three recent surveys enrolling the largest number of patients reported a more consistent prevalence of 30-40% (2,3,6). Severe anemia, requiring treatment based on current guidelines, is less frequent with an estimated prevalence of about 10-15% (2,6).…”

Section: Introductionmentioning

confidence: 99%

Anemia Is Associated with Mortality in Kidney-Transplanted Patients—A Prospective Cohort Study

Molnar

Czira

Csaba

et al. 2007

American Journal of Transplantation

147

118

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Although anemia is a known risk factor of mortality in several patient populations, no prospective study to date has demonstrated association between anemia and mortality in kidney-transplanted patients. In our prospective cohort study (TransQol-HU Study), we tested the hypothesis that anemia is associated with mortality and graft failure (return to dialysis) in transplanted patients. Data from 938 transplanted patients, followed at a single outpatient transplant center, were analyzed. Sociodemographic parameters, laboratory data, medical history and information on comorbidity were collected at baseline. Data on 4-year outcome (graft failure, mortality or combination of both) were collected prospectively from the patients' charts. Both mortality and graft failure rate during the 4-year follow-up was significantly higher in patients who were anemic at baseline (for anemic vs nonanemic patients, respectively: mortality 18% vs. 10%; p < 0.001; graft failure 17% vs 6%; p < 0.001). In multivariate Cox proportional hazard models the presence of anemia significantly predicted mortality (HR = 1.690; 95% CI: 1.115-2.560) and also graft failure (HR = 2.465; 95% CI: 1.485-4.090) after adjustment for several covariables. Anemia, which is a treatable complication, is significantly and independently associated with mortality and graft failure in kidney-transplanted patients.

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“…To date, there have been few studies of late PTA. In a cross-sectional study assessing the prevalence of late PTA, Saito et al (24) reported a 23.3% prevalence of anemia (defined as Hgb: males, Ͻ 12.8 g/dL; females, Ͻ 11.5 g/dL). In the only longitudinal study (0-24 months post transplantation), in which mean hemoglobin levels were quantified relative to specific immunosuppressive regimens, Kahng et al reported that anemia was corrected in most patients by 8 months post transplant and that early iron therapy, particularly in females, reduced the incidence of anemia (25).…”

Section: Introductionmentioning

confidence: 99%