Anemia After Kidney Transplantation; Its Prevalence, Risk Factors, and Independent Association With Graft and Patient Survival: A Time-Varying Analysis

Anemia After Kidney Transplantation; Its Prevalence, Risk Factors, and Independent Association With Graft and Patient Survival: A Time-Varying Analysis: Introduction: Posttransplant anemia and its association with transplant outcomes have not been properly studied.
Methods: We examined 530 renal allograft recipients transplanted at our center and followed up for 31.0±14.1 months. Hemoglobin (Hb), serum bicarbonate, and creatinine; use of erythropoiesis-stimulating agent (ESA) and iron; and immunosuppressive regimen data were obtained at multiple time points during 24-month posttransplant.
Results: The overall prevalence of anemia was 89.4% at the time of transplant, dropping to 49.2% at 1 year and 44.3% at 2 years. ESA use decreased from 25.6% at 1 month to 8.23% at 24 months, only in 30.9% to 51.2% with severe anemia; 21.0% to 29.2% received iron supplements. Factors independently predictive of Hb included male gender (β=0.64, P<0.001, confidence interval [CI]: 0.45–0.82), estimated glomerular filtration rate (β=0.21 per 10 mL/min/1.73 m2, P<0.001; CI: 0.16–0.27), bicarbonate (β=0.4 per 10 mmol/L increase, P<0.001; CI: 0.31–0.85), using angiotensin-converting enzyme inhibitor/angiotensin receptor blocker (β=0.36, P<0.001; CI: 0.16–0.55), African American race (β=−0.34, P=0.001, CI:−0.54 to −0.14), iron (β=−0.28, P=0.003, CI:−0.47 to −0.09) and ESA use (β=−0.73, P<0.001, CI:−0.93 to −0.52), and prednisone (β=−0.46, P<0.001, CI:−0.71 to −0.22 for >10 mg/day vs. none). Using a competing-risk regression model, Hb less than 9 in men and less than 8 in women, was associated with 5.25-fold higher risk of death-censored graft loss compared with no anemia (adjusted, P=0.005, CI: 1.7–16.7). Degree of anemia also remained significantly associated with risk of death (hazard ratio [HR]: 2.2, P<0.1, CI: 0.9–5.6 for grade 2; HR: 3.9, P=0.009, CI: 1.4–10.8 for grade 3; and HR: 4.8, P=0.08, CI: 1.5–15.4 for grade 4, all vs. grade 0).
Conclusion: We showed that posttransplant anemia is common, and ESA/iron use remains suboptimal, and Hb is independently associated with graft failure and mortality.

Correction of Postkidney Transplant Anemia Reduces Progression of Allograft Nephropathy

Correction of Postkidney Transplant Anemia Reduces Progression of Allograft Nephropathy:
Retrospective studies suggest that chronic allograft nephropathy might progress more rapidly in patients with post-transplant anemia, but whether correction of anemia improves renal outcomes is unknown. An open-label, multicenter, randomized controlled trial investigated the effect of epoetin-β to normalize hemoglobin values (13.0–15.0 g/dl, n=63) compared with partial correction of anemia (10.5–11.5 g/dl, n=62) on progression of nephropathy in transplant recipients with hemoglobin <11.5 g/dl and an estimated creatinine clearance (eCrCl) <50 ml/min per 1.73 m².

A Randomized Controlled Trial of Intravenous or Oral Iron for Posttransplant Anemia in Kidney Transplantation

A Randomized Controlled Trial of Intravenous or Oral Iron for Posttransplant Anemia in Kidney Transplantation: Background: Anemia after kidney transplantation has been associated with poor transplant outcomes. We hypothesized that intravenous (IV) iron may more rapidly correct anemia than oral (PO) iron.
Methods: One hundred four kidney transplant recipients were prospectively randomized to IV iron polymaltose (500 mg single dose) or PO ferrous sulfate (210 mg elemental iron daily, continuously). The primary outcome was time to resolution of anemia, defined as hemoglobin more than or equal to 11 g/dL. Secondary outcomes included infections, blood transfusions, gastrointestinal side-effects, and acute rejection.