Anemia in Kidney Transplants Without Erythropoietic Agents: Levels of Erythropoietin and Iron Parameters

Abstract Aim To study the association between hemoglobin, endogenous erythropoietin (EPO) levels and ferric parameters in kidney recipients not treated with EPO-stimulating agents. Materials and methods Transverse study of 219 kidney transplant outpatients. The median time after transplantation was...

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Bibliographic Details
Published in:	Transplantation proceedings Vol. 44; no. 9; pp. 2590 - 2592
Main Authors:	Florit, E.A, Hadad, F, Rodriguez Cubillo, B, De la Flor, J.C, Valga, F, Perez Flores, I, Calvo Romero, N, Valero San Cecilio, R, Barrientos Guzman, A, Sanchez Fructuoso, A
Format:	Journal Article Conference Proceeding
Language:	English
Published:	Amsterdam Elsevier Inc 01-11-2012 Elsevier
Subjects:	Adult Aged Anemia - blood Anemia - epidemiology Anemias. Hemoglobinopathies Angiotensin II Type 1 Receptor Blockers - adverse effects Angiotensin-Converting Enzyme Inhibitors - adverse effects Biological and medical sciences Biomarkers - blood Cross-Sectional Studies Diseases of red blood cells Erythropoietin - blood Female Ferritins - blood Fundamental and applied biological sciences. Psychology Fundamental immunology Hematologic and hematopoietic diseases Hemoglobins - analysis Humans Immunosuppressive Agents - adverse effects Incidence Iron - blood Kidney - physiopathology Kidney Transplantation - adverse effects Linear Models Male Medical sciences Middle Aged Protein Kinase Inhibitors - adverse effects Risk Factors Spain - epidemiology Surgery Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases Time Factors Tissue, organ and graft immunology TOR Serine-Threonine Kinases - antagonists & inhibitors Transferrin - analysis Spain Erythropoiesis Erythropoietin Anemia Hemopathy Iron Transplantation Homotransplantation Inorganic element Kidney Medicine Treatment Urinary system Polypeptide Surgery Graft Parameter
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Summary:	Abstract Aim To study the association between hemoglobin, endogenous erythropoietin (EPO) levels and ferric parameters in kidney recipients not treated with EPO-stimulating agents. Materials and methods Transverse study of 219 kidney transplant outpatients. The median time after transplantation was 54 months (P25–75 , 23–107). We assessed blood counts, ferric parameters, EPO levels, renal function (MDRD-4), and adjuvant treatment. We performed a linear regression analysis to predict hemoglobin. Results Median EPO values were 14.05 mUI/mL (P25–75 = 10.2–19.7). Applying the formulas described by Beguin, kidney transplant recipients showed a low observed/expected ratio of erythropoietin and of transferrin. Considering anemia to be an hemoglobin of < 12 g/dL in women and < 13 g/dL in men, 24.2% of subjects were anemic ( n = 53), including 2.3% with hemoglobin < 11 g/dL. Anemic patients displayed worse renal function (49.2 ± 18.5 versus 55.46 ± 16.58 mL/min/1.73 m2 in nonanemic; P = .021). There were no differences in C-reactive protein. The patients receiving a combination of angiotensin-converting enzyme inhibitors (ACEI) and angiotensin II receptor blockers (ARB) showed the highest prevalence of anemia compared with other groups (42.9%, P = .027). EPO levels were significantly lower among patients treated with these drugs ( P = .041), without differences in transferrin and ferritin. The percentage of anemic patients treated with mammalian target of rapamycin inhibitors (mTORi) was 31% versus 22.2% among those not receiving these immunosuppressants ( P = .23). Although there were no differences in hemoglobin levels, patients treated with mTORi, showed higher EPO levels ( P = .005) and lower mean corpuscular volume ( P < .001). Regarding the etiology of chronic kidney disease, less frequently anemic patients were those with polycystic kidney disease (8.6% versus 26.7% in the rest, P = .021). The formula obtained by multiple linear regression to calculate hemoglobin was: hemoglobin = 11829–0909 * log (EPG level) − 0455 (if female) + 0.010 * 0.013 * transferrin + 0.013 * creatinine clearance (r = .424, P < .001). Conclusions Treatment with ACEI and/or ARBs seemed to produce a defect in the synthesis of EPO, while those treated with mTORi, a hyporesponsive state.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	0041-1345 1873-2623
DOI:	10.1016/j.transproceed.2012.09.044