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Anemia: A Continuing Problem Following Kidney Transplantation

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Dr Prof. Dinesh Khullar    14 October 2017

Post transplant anemia remains a common problem after kidney transplantation with an incidence ranging from nearly 80 at Day 0 to about 25 at 1 year. It has been associated with poor graft outcome and recently has also been shown to be associated with increased mortality. Post transplant anemia can occur any time after the transplant and can be from a number of different causes including blood loss from the surgery iron deficiency immunosuppression infection or inflammation. Blood transfusions for the management of anemia in transplant patients may increase the risk of alloreactivity and rejection episodes after kidney transplantation. The available evidence in transplant patients however indicates that ESA therapy is effective in increasing Hb levels. Correction of post transplant anemia with ESA is associated with improved QoL. Oral iron products are usually prescribed but are not always optimal due to gastrointestinal intolerance and concerns regarding the decreased absorption of concomitant immunosuppressant medications. IV iron enables the administration of a larger dose of iron and may increase compliance compared with the oral preparation. Only few studies have examined the role of iron supplementation after kidney transplantation and the data regarding the efficacy and safety of IV iron treatment in this patient population are scarce. The safety and tolerability of the new IV iron preparation ferric carboxymaltose FCM has been assessed in patients with CKD and in kidney transplant recipients in a small study wherein FCM had excellent safety and tolerability with no change in eGFR. Compared with other IV iron preparations the considerably shorter administration time of FCM allows saving time and it also reduces costs. Anemia was common after kidney transplantation and persists in a large proportion of kidney transplant recipients. Female gender lower GFR and lower hematocrit appear to be important predictors of anemia at 6 and 12 months after transplantation. The investigation and treatment of anemia was suboptimal during the timeframe of the study. This highlights a lack of attentiveness to risk factors that have potential for causing increased morbidity. Increased awareness timely diagnosis and treatment of anemia after kidney transplantation could be an important strategy to improve CV outcomes in this high risk population.

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