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Anaemia Following Renal Transplantation
multivariate logistic regression analysis, ACEi use was independently Additional Factors
associated with anaemia (OR 1.86). In the TRESAM study,
25.9% of Other factors have been implicated in the pathogenesis of PTA. Female
patients received an ACEi and 10.3% an ARB. There was no significant gender may be relevant in the aetiology of PTA due to the potential
difference in Hb levels or the presence of anaemia between patients for blood loss following the return of reproductive function and
receiving ACEi and those who were ACEi-naïve. In those regular menses. In a study of 1,511 post-renal-transplant patients,
patients prescribed an ARB, the Hb level was significantly lower than in Shah and co-workers
found a significantly higher mean Hb in males
those not prescribed an ARB (12.9±2.0 versus 13.2±1.9g/dl; p<0.01). than in females (13.3±1.6 versus 12.3±1.4g/dl; p<0.0001). Of this
Although statistically significant, the clinical significance of this difference cohort, 44.1% of males and 48.1% of females were anaemic.
is questionable. When combining the use of an ACEi or an ARB, the However, these results are confounded by the presence of better graft
authors report an OR of 1.55 for being anaemic. After multiple regression function in the male population (49.9±19.0 versus 43.8±18.0ml/min;
analysis, Shah and co-workers
also found a moderate association p<0.0001). In another study, women were noted to be three- to four-
between ACEi/ARB use and lower Hb levels. However, other studies do fold more likely than men to have an HCT <36% six months and one
not support the association of ACEi/ARB use with PTA.
year following transplantation.
Female gender has been associated
with PTA elsewhere in the literature as well.
In contrast to this,
Erythropoietin Levels the authors of TRESAM
found that although female transplant
A limited number of studies have included erythropoietin (EPO) levels recipients had a lower mean Hb compared with the male recipients
in their analysis of PTA.
A transient rise in EPO levels is (12.6±1.7 versus 13.5±1.9g/dl; p<0.01), the prevalence of anaemia
demonstrated following engraftment, which may not be associated did not differ by gender. This has been replicated elsewhere.
with an erythropoietic response. A subsequent smaller rise is
associated with allograft recovery and resolution of anaemia.
PTA was more prevalent in African-Americans in some studies
Erythropoiesis and correction of anaemia continue despite the and has also been related to delayed graft function,
normalisation of EPO levels once the HCT increases beyond 32%.
status with or without chronic inflammation
Hb levels are generally restored to normal between two and six (CMV) status.
months after transplantation.
In a study of 207 renal transplant
a significant negative correlation between Hb levels and Conclusion
EPO levels (Pearson’s correlation coefficient, R=-0.29; p<0.001) was Anaemia following transplantation is a common phenomenon. Its
found – i.e. those with lower Hb levels had higher EPO levels and vice pathogenesis is multifactorial in nature, with possible contributions
versa. However, there was no association between the eGFR and EPO from graft function, immunosuppressive regimen, ACEi/ARB use,
levels (R=0.02; p=0.74), indicating that factors other than graft erythropoietin levels and gender, among others. A standardised
function were influencing the EPO levels. In multivariate regression definition of anaemia following renal transplantation along with
analysis, serum EPO levels were negatively predictive of Hb levels and prospective trials in this area should help to further elucidate the
also of anaemia independent of renal function. In those anaemic aetiology of PTA. Earlier recognition and adequate management may
patients with stable, good graft function, other factors including EPO reduce the significant number of adverse cardiovascular events seen in
deficiency or resistance may play a role.
this cohort. ■
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