Anemia in the kidney-transplant patient

Heidi Joist, Daniel Brennan, Daniel W. Coyne

Research output: Contribution to journalReview article

Abstract

Anemia, a potentially correctable cardiovascular risk factor, continues to be a major problem in kidney-transplant patients. Erythropoietin levels increase rapidly after successful kidney transplantation, and by 3 months, most patients achieve hemoglobin levels greater than 12 g/dL. Anemia may be caused by problems commonly seen in the general population such as iron deficiency or gastrointestinal blood loss, by immunosuppressive medications, or by more rare abnormalities such as hemolytic uremic syndrome or parvovirus B19-induced aplastic anemia. Iron deficiency is common at the time of transplantation and beyond and frequently contributes to anemia. Markers of iron deficiency (ferritin or transferrin saturation) are frequently inconclusive because of the presence of inflammation and infection. Immunosuppressive medications, such as azathioprine and mycophenolate mofetil (MMF), are a common cause of mild bone-marrow suppression and, thus, anemia. Sirolimus can cause more severe bone-marrow suppression, although this effect can lessen over time. The transplant patient with chronic kidney disease (CKD) frequently develops anemia, yet agents such as epoetin-α and darbepoetin are greatly underutilized. Evaluation of anemia should be undertaken when hemoglobin fails to normalize by 3 months after transplantation. Later after transplantation, especially in the setting of chronic allograft dysfunction, evaluation should take place when the hemoglobin falls to less than 11 g/dL in premenopausal females or to less than 12 g/dL in males and postmenopausal females.

Original languageEnglish (US)
Pages (from-to)4-10
Number of pages7
JournalAdvances in Chronic Kidney Disease
Volume13
Issue number1
DOIs
StatePublished - Jan 1 2006
Externally publishedYes

Fingerprint

Anemia
Transplants
Kidney
Hemoglobins
Iron
Transplantation
Immunosuppressive Agents
Bone Marrow
Mycophenolic Acid
Parvovirus
Hemolytic-Uremic Syndrome
Aplastic Anemia
Azathioprine
Sirolimus
Transferrin
Ferritins
Erythropoietin
Chronic Renal Insufficiency
Kidney Transplantation
Allografts

Keywords

  • Anemia
  • Epoetin
  • Iron deficiency
  • Kidney transplantation

ASJC Scopus subject areas

  • Nephrology

Cite this

Anemia in the kidney-transplant patient. / Joist, Heidi; Brennan, Daniel; Coyne, Daniel W.

In: Advances in Chronic Kidney Disease, Vol. 13, No. 1, 01.01.2006, p. 4-10.

Research output: Contribution to journalReview article

Joist, Heidi ; Brennan, Daniel ; Coyne, Daniel W. / Anemia in the kidney-transplant patient. In: Advances in Chronic Kidney Disease. 2006 ; Vol. 13, No. 1. pp. 4-10.
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