The current therapeutic approach for anaemia after kidney transplant

Abstract

Purpose of reviewAnaemia after kidney transplantation is a common finding with no uniform management guideline. Most approaches are derived from the chronic kidney disease (CKD) population. Recent advances for the treatment of anaemia in patients with CKD/End stage renal disease include hypoxia-inducible factor-prolyl hydroxylase inhibitor (HIF-PHi), a novel class of oral erythropoietin-stimulating agents (ESAs). We present relevant studies of HIF-PHi in the transplant population and its implications on the management of posttransplant anaemia.Recent findingsData on HIF-PHi use in the kidney transplant population are promising. Limited data demonstrate a significant increase in haemoglobin, with a comparable safety profile to epoetin. Reported adverse effects include overcorrection and low iron stores.SummaryCurrent therapeutic approaches to anaemia in the kidney transplant population is mostly derived from the CKD population. More studies are needed on HIF-Phi, a novel class of ESAs that has thus far demonstrated promise in the kidney transplant population.

Treatment Options for Anemia in Kidney Transplant Patients: A Review

“…Several pathogens, mainly viruses, may increase the risk of anemia by direct bone marrow suppression or indirect effects such as increased inflammation causing impaired erythropoiesis. 19 , 20 The time of infectious disease onset is usually in the first few months after transplant surgery, which is consistent with the stronger immunosuppression therapy during that period. 21 However, parvovirus B19 infection, strongly suggested by a very low percentage (<1%) in the reticulocyte count, may occur as early as 2 weeks after KT.…”

“…From the current evidence on the use of HIF-PH inhibitors in KT, it is advisable to start with a low dose and slowly increase the titration and supplementing iron owing to increased iron utilization. 20 RCT studies are needed to elucidate the long-term efficacy and safety of HIF-PH inhibitors in anemic KTRs.…”