Iron deficiency after kidney transplantation

Vinke, Joanna Sophia J; Francke, Marith I.; Eisenga, Michele F.; Hesselink, Dennis A.; Borst, Martin H. de

doi:10.1093/ndt/gfaa123

Cited by 15 publications

(14 citation statements)

References 121 publications

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“…The concomitant use of MMF and the laxative calcium polycarbophil leads to a decrease in MPA absorption and a reduced AUC and Cmax by more than 50%. 102 Iron supplements, commonly prescribed to transplant patients to alleviate iron deficient anemia, 103 can reduce the AUC and Cmax of MPA by 90%. 104…”

Section: Laxatives and Iron Supplementsmentioning

confidence: 99%

Personalized Therapy for Mycophenolate: Consensus Report by the International Association of Therapeutic Drug Monitoring and Clinical Toxicology

Bergan¹,

Brunet²,

Hesselink³

et al. 2021

Therapeutic Drug Monitoring

133

237

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When mycophenolic acid (MPA) was originally marketed for immunosuppressive therapy, fixed doses were recommended by the manufacturer. Awareness of the potential for a more personalized dosing has led to development of methods to estimate MPA area under the curve based on the measurement of drug concentrations in only a few samples. This approach is feasible in the clinical routine and has proven successful in terms of correlation with outcome. However, the search for superior correlates has continued, and numerous studies in search of biomarkers that could better predict the perfect dosage for the individual patient have been published. As it was considered timely for an updated and

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Section: Laxatives and Iron Supplementsmentioning

confidence: 99%

Personalized Therapy for Mycophenolate: Consensus Report by the International Association of Therapeutic Drug Monitoring and Clinical Toxicology

Bergan¹,

Brunet²,

Hesselink³

et al. 2021

Therapeutic Drug Monitoring

133

237

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“…Post‐transplantation anaemia, affecting 12–39% of KTRs, 8 , 9 can be caused by a wide variety of factors, including low‐grade inflammation, iron deficiency, erythropoietin deficiency, and the use of immunosuppressive medication, angiotensin‐converting enzyme inhibitors and angiotensin receptor blockers. 10 , 11 In KTRs, anaemia has been associated with an increased risk of cardiovascular and all‐cause mortality as well as allograft failure. 12 , 13 , 14 , 15 Recent studies in non‐transplant populations, such as the general population 7 and the elderly, 16 have linked lower haemoglobin levels to reduced muscle mass.…”

Section: Introductionmentioning

confidence: 99%

Decreased haemoglobin levels are associated with lower muscle mass and strength in kidney transplant recipients

Vinke

Wouters

Stam

et al. 2022

J cachexia sarcopenia muscle

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Background Post-transplant anaemia and reduced muscle mass and strength are highly prevalent in kidney transplant recipients (KTRs). Decreased haemoglobin levels, a marker of anaemia, could adversely affect muscle mass and strength through multiple mechanisms, among others, through diminished tissue oxygenation. We aimed to investigate the association between haemoglobin levels with muscle mass and strength in KTRs. Methods We included stable KTRs from the TransplantLines Biobank and Cohort study with a functional graft ≥1 year post-transplantation. Muscle mass was assessed using 24 h urinary creatinine excretion rate (CER) and bioelectrical impedance analysis (BIA). Muscle strength was assessed with a handgrip strength test using a dynamometer and, in a subgroup (n = 290), with the five-times sit-to-stand (FTSTS) test. We used multivariable linear and logistic regression analyses to investigate the associations of haemoglobin levels with muscle mass and strength. ResultsIn 871 included KTRs [median age 58 (interquartile range (IQR), 48-66)] years; 60% men; eGFR 51 ± 18 mL/min/1.73 m 2 ) who were 3.5 (1.0-10.2) years post-transplantation, the mean serum haemoglobin level was 13.9 ± 1.8 g/dL in men and 12.8 ± 1.5 g/dL in women. Lower haemoglobin levels were independently associated with a lower CER (std. β = 0.07, P = 0.01), BIA-derived skeletal muscle mass (std. β = 0.22, P < 0.001), handgrip strength (std. β = 0.15, P < 0.001), and worse FTSTS test scores (std. β = À0.17, P = 0.02). KTRs in the lowest age-specific and sex-specific quartile of haemoglobin levels had an increased risk of being in the worst age-specific and sex-specific quartile of CER (fully adjusted OR, 2.09; 95% CI 1.15-3.77; P = 0.02), handgrip strength (fully adjusted OR, 3.30; 95% CI 1.95-5.59; P < 0.001), and FTSTS test score (fully adjusted OR, 7.21; 95% CI 2.59-20.05; P < 0.001). Conclusions Low haemoglobin levels are strongly associated with decreased muscle mass and strength in KTRs. Future investigation will need to investigate whether maintaining higher haemoglobin levels may improve muscle mass and strength in KTRs.

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“…Late anemia (>6 months) is mainly caused by impaired kidney graft function and defective erythropoietin production. Iron deficiency is common and is associated with an increased mortality risk in KT recipients [ 152 ]. ACEi, azathioprine, mycophenolate salts, mTOR inhibitors and viral infections may trigger or aggravate anemia.…”

Section: Anemiamentioning

confidence: 99%

Cardiovascular Risk after Kidney Transplantation: Causes and Current Approaches to a Relevant Burden

Reggiani

Moroni

Ponticelli³

2022

JPM

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Background. Cardiovascular disease is a frequent complication after kidney transplantation and represents the leading cause of mortality in this population. Material and Methods. We searched for the relevant articles in the National Institutes of Health library of medicine, transplant, cardiologic and nephrological journals. Results. The pathogenesis of cardiovascular disease in kidney transplant is multifactorial. Apart from non-modifiable risk factors, such as age, gender, genetic predisposition and ethnicity, several traditional and non-traditional modifiable risk factors contribute to its development. Traditional factors, such as diabetes, hypertension and dyslipidemia, may be present before and may worsen after transplantation. Immunosuppressants and impaired graft function may strongly influence the exacerbation of these comorbidities. However, in the last years, several studies showed that many other cardiovascular risk factors may be involved in kidney transplantation, including hyperuricemia, inflammation, low klotho and elevated Fibroblast Growth Factor 23 levels, deficient levels of vitamin D, vascular calcifications, anemia and poor physical activity and quality of life. Conclusions. The timely and effective treatment of time-honored and recently discovered modifiable risk factors represent the basis of the prevention of cardiovascular complications in kidney transplantation. Reduction of cardiovascular risk can improve the life expectancy, the quality of life and the allograft function and survival.

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Iron deficiency after kidney transplantation

Cited by 15 publications

References 121 publications

Personalized Therapy for Mycophenolate: Consensus Report by the International Association of Therapeutic Drug Monitoring and Clinical Toxicology

Personalized Therapy for Mycophenolate: Consensus Report by the International Association of Therapeutic Drug Monitoring and Clinical Toxicology

Decreased haemoglobin levels are associated with lower muscle mass and strength in kidney transplant recipients

Cardiovascular Risk after Kidney Transplantation: Causes and Current Approaches to a Relevant Burden

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