1
|
Nagib AM, Gheith OA, Zahab MA, Balaha MA, Elserwey NA, Sobhy I, Nair P, Al-Otaibi T. Pure Red Cell Aplasia in a Renal Transplant Recipient: Case Report and Review of the Literature. EXP CLIN TRANSPLANT 2022; 20:136-139. [PMID: 35384824 DOI: 10.6002/ect.mesot2021.p66] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Severe anemia requiring multiple blood transfusions in the posttransplant period can trigger rejection. The evaluation of anemia among transplant recipients is a challenging task. Awareness should be continued for tacrolimus to manage pure red cell aplasia, but further evidence is needed to prove whether tacrolimus is a real cause of posttransplant anemia. Our case patient, a 66-year-old male patient with end-stage renal disease due to diabetic nephropathy, underwent a preemptive living donor renal transplant in September 2018. He had received a coronary artery bypass graft with transcatheter aortic valve implantation 3 years before renal transplant. Initially, he was maintained on prednisolone, mycophenolate mofetil, and tacrolimus after basiliximab induction. One month later, he presented with low cardiac output symptoms. His complete blood count showed normocytic normochromic anemia with reticulocytopenia (his hemoglobin level dropped from 112 to 69 g/L), which necessitated regular blood transfusions. His iron profile, serum folate, and vitamin B12 were within normal limits, and he had negative hemolytic and autoimmune screening tests. A bone marrow biopsy revealed acquired pure red cell aplasia, which was most likely drug induced as viral profiles were negative for parvovirus B19, cytomegalovirus, and Epstein-Barr virus. The patient was managed by discontinuing mycophenolate mofetil, and the steroid dose was increased up to 20 mg/day but without improvement. With tacrolimus then considered, 3 weeks after presentation, we replaced tacrolimus with cyclosporine. Complete blood count follow-up showed improvement without any need for further blood transfusions. After 1 month of cyclosporine maintenance, mycophenolate mofetil was resumed with a steady increase of hemoglobin up to 150 g/L and serum creatinine of 122 μmol/L. Pure red cell aplasia is a rare disorder among renal transplant recipients, which could be induced by maintenance tacrolimus therapy.
Collapse
Affiliation(s)
- Ayman M Nagib
- From the Nephrology Department, Hamed Al-Essa Organ Transplant Center, Sabah Area, Kuwait.,From the Nephrology Department of Dialysis and Transplantation, Urology Nephrology Center, Mansoura University, Mansoura, Egypt
| | | | | | | | | | | | | | | |
Collapse
|
2
|
Hanna RM, Streja E, Kalantar-Zadeh K. Burden of Anemia in Chronic Kidney Disease: Beyond Erythropoietin. Adv Ther 2021; 38:52-75. [PMID: 33123967 PMCID: PMC7854472 DOI: 10.1007/s12325-020-01524-6] [Citation(s) in RCA: 50] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 10/03/2020] [Indexed: 02/08/2023]
Abstract
Anemia is a frequent comorbidity of chronic kidney disease (CKD) and is associated with a considerable burden because of decreased patient health-related quality of life and increased healthcare resource utilization. Based on observational data, anemia is associated with an increased risk of CKD progression, cardiovascular events, and all-cause mortality. The current standard of care includes oral or intravenous iron supplementation, erythropoiesis-stimulating agents, and red blood cell transfusion. However, each of these therapies has its own set of population-specific patient concerns, including increased risk of cardiovascular disease, thrombosis, and mortality. Patients receiving dialysis or those who have concurrent diabetes or high blood pressure may be at greater risk of developing these complications. In particular, treatment with high doses of erythropoiesis-stimulating agents has been associated with increased rates of hospitalization, cardiovascular events, and mortality. Resistance to erythropoiesis-stimulating agents remains a therapeutic challenge in a subset of patients. Hypoxia-inducible factor transcription factors, which regulate several genes involved in erythropoiesis and iron metabolism, can be stabilized by a new class of drugs that act as inhibitors of hypoxia-inducible factor prolyl-hydroxylase enzymes to promote erythropoiesis and elevate hemoglobin levels. Here, we review the burden of anemia of chronic kidney disease, the shortcomings of current standard of care, and the potential practical advantages of hypoxia-inducible factor prolyl-hydroxylase inhibitors in the treatment of patients with anemia of CKD.
Collapse
Affiliation(s)
- Ramy M Hanna
- Division of Nephrology, Hypertension and Kidney Transplantation, Harold Simmons Center for Kidney Disease Research and Epidemiology, University of California, Irvine School of Medicine, Orange, CA, USA
| | - Elani Streja
- Division of Nephrology and Hypertension, University of California, Irvine School of Medicine, Orange, CA, USA
| | - Kamyar Kalantar-Zadeh
- Division of Nephrology and Hypertension, University of California, Irvine School of Medicine, Orange, CA, USA.
| |
Collapse
|
3
|
Cruz-Santiago J, Velázquez-Zambrano C, Escamilla-Galindo PA, Díaz-Rosas G, Rojas-Rodríguez FO, Venegas-Vera ÁV, López-López B, Bernáldez-Gómez G, Colbert GB, Mejía Velázquez JL, Aguilera-Vallejo JE, Hernández-Rivera JCH, Paniagua-Sierra R. Change in the Pattern of Posttransplantation Anemia in Kidney Receptors: Sex Role in Recipients and Type of Donor. Transplant Proc 2020; 52:1163-1168. [PMID: 32199647 DOI: 10.1016/j.transproceed.2019.12.050] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Accepted: 12/06/2019] [Indexed: 10/24/2022]
Abstract
OBJECTIVE Posttransplant anemia (PTA) in kidney recipients is a complication that has repercussions mainly of cardiovascular consequence. The objective of this study is to determine the prevalence of anemia, as well as the relationship between kidney recipient and donor sex, in the presence or absence of anemia at 12 months after kidney transplant (KT). MATERIAL AND METHODS Observational, longitudinal study of KTs made over a 5-year period, from 2013 to 2017, in a renal transplant unit from La Raza National Health Care Medical Center. Three hundred twenty-eight records were analyzed. Hemoglobin (Hb) and the presence or absence of anemia according to the definition by the World Health Organization were analyzed. The association between kidney recipient sex and donor type (living or deceased) was evaluated. Analysis of central tendency and dispersion were performed and the mean difference was established with χ2 test or Student t test. Significance level was set at P < .05. RESULTS The mean Hb (standard deviation) before KT was 10.38 (2.16) g/dL; Hb at 12 months was 14.47 (2.37) g/dL with an absolute increase of 4.09 g/dL. Before KT, male kidney recipients had a mean Hb of 10.54 (2.17) g/dL. At 12 months post-KT, mean Hb was 15.33 (2.25) with a change of 4.79 g/dL. Before KT, female kidney recipients had a mean Hb of 10.16 (2.13) g/dL. At 12 months post-KT, mean Hb was 13.31 (2.01) with a change of 3.15 g/dL. The difference between both sexes was 1.64 g/dL at the end of 12 months. Sixteen out of 152 (10.5%) patients had a serum creatinine (Cr) < 1.2 mg/dL and anemia; 36 out of 176 (20.5%) patients had a Cr ≥ 1.2 mg/dL and anemia (P = .014). In the bivariate logistic regression with an odds ratio of 2.047 (95% confidence interval, 1027-4078; P = .042) for higher Cr levels and the presence of persistent anemia. CONCLUSIONS There is a prevalence of anemia in female kidney recipients and recipients of kidneys from deceased donors. There is a higher risk of persistent anemia in the case of patients with some degree of graft failure at 12 months.
Collapse
Affiliation(s)
- José Cruz-Santiago
- Renal Transplant Unit, La Raza National Health Care Medical Center, Mexican Social Security Institute, México City, México
| | - Carmen Velázquez-Zambrano
- Renal Transplant Unit, La Raza National Health Care Medical Center, Mexican Social Security Institute, México City, México
| | - Pedro Aarón Escamilla-Galindo
- Renal Transplant Unit, La Raza National Health Care Medical Center, Mexican Social Security Institute, México City, México
| | - Gabriela Díaz-Rosas
- Renal Transplant Unit, La Raza National Health Care Medical Center, Mexican Social Security Institute, México City, México
| | - Felipe Octavio Rojas-Rodríguez
- Renal Transplant Unit, La Raza National Health Care Medical Center, Mexican Social Security Institute, México City, México
| | - Ángel Verner Venegas-Vera
- Renal Transplant Unit, La Raza National Health Care Medical Center, Mexican Social Security Institute, México City, México
| | - Bibiana López-López
- Renal Transplant Unit, La Raza National Health Care Medical Center, Mexican Social Security Institute, México City, México
| | - German Bernáldez-Gómez
- Renal Transplant Unit, La Raza National Health Care Medical Center, Mexican Social Security Institute, México City, México
| | | | - Jorge Luís Mejía Velázquez
- Nephrology Service, La Raza National Health Care Medical Center, Mexican Social Security Institute, México City, México; Kidney Diseases Medical Research Unit, 21st Century National Medical Center, Mexican Social Security Institute, México City, México
| | - Jesús Eduardo Aguilera-Vallejo
- Kidney Diseases Medical Research Unit, 21st Century National Medical Center, Mexican Social Security Institute, México City, México
| | - Juan Carlos H Hernández-Rivera
- Kidney Diseases Medical Research Unit, 21st Century National Medical Center, Mexican Social Security Institute, México City, México.
| | - Ramón Paniagua-Sierra
- Kidney Diseases Medical Research Unit, 21st Century National Medical Center, Mexican Social Security Institute, México City, México
| |
Collapse
|
4
|
Lim AKH, Kansal A, Kanellis J. Factors associated with anaemia in kidney transplant recipients in the first year after transplantation: a cross-sectional study. BMC Nephrol 2018; 19:252. [PMID: 30290796 PMCID: PMC6173839 DOI: 10.1186/s12882-018-1054-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2017] [Accepted: 09/24/2018] [Indexed: 11/13/2022] Open
Abstract
Background Anaemia after kidney transplantation may reduce quality of life, graft or patient survival. We aimed to determine the prevalence and risk factors for anaemia in the initial 12 months after transplantation. Methods We conducted a cross-sectional study at 6 and 12 months after transplantation. Anaemia was defined by World Health Organization criteria taking into consideration erythropoietin use. Logistic regression was used to determine the association between demographic, clinical and pharmacological risk factors for the main outcome of moderate-severe anaemia. Results A total of 336 transplant recipients were included and the prevalence of moderate-severe anaemia was 27.4% at 6 months and 15.2% at 12 months. Lower kidney function, female gender, transferrin saturation below 10% and proteinuria were associated with moderate-severe anaemia at both time points. Recent intravenous immunoglobulin treatment was associated with anaemia at 6 months. Recent infection and acute rejection were also associated with anaemia 12 months. Around 20% of patients had at least one blood transfusion but they were uncommon beyond 3 months. Conclusions Anaemia remains highly prevalent requiring treatment with erythropoietin and transfusions. Most identifiable risk factors relate to clinical problems rather than pharmacological management, while markers of iron-deficiency remain difficult to interpret in this setting. Electronic supplementary material The online version of this article (10.1186/s12882-018-1054-7) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Andy K H Lim
- Department of Nephrology, Monash Health, Clayton, Victoria, 3168, Australia. .,Department of Medicine, Monash University, Clayton, Victoria, 3168, Australia.
| | - Arushi Kansal
- Department of Nephrology, Monash Health, Clayton, Victoria, 3168, Australia
| | - John Kanellis
- Department of Nephrology, Monash Health, Clayton, Victoria, 3168, Australia.,Department of Medicine, Monash University, Clayton, Victoria, 3168, Australia
| |
Collapse
|
5
|
Lima P, Campos A, Corrêa C, Dias C, Mostarda C, Amorim C, Garcia A. Effects of Chronic Physical Activity on Glomerular Filtration Rate, Creatinine, and the Markers of Anemia of Kidney Transplantation Patients. Transplant Proc 2018; 50:746-749. [DOI: 10.1016/j.transproceed.2018.02.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
|
6
|
Higher blood pressure during light exercise is associated with increased left ventricular mass index in normotensive subjects. Hypertens Res 2018. [DOI: 10.1038/s41440-018-0028-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
7
|
Miettinen J, Tainio J, Jahnukainen T, Pakarinen M, Lauronen J, Jalanko H. Anemia and low-grade inflammation in pediatric kidney transplant recipients. Pediatr Nephrol 2017; 32:347-358. [PMID: 27576676 DOI: 10.1007/s00467-016-3481-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Revised: 07/23/2016] [Accepted: 07/27/2016] [Indexed: 12/15/2022]
Abstract
BACKGROUND Anemia and low-grade inflammation are reported to be associated with impaired long-term graft outcome in renal transplant (RTx) recipients. In this study, hemoglobin (Hb) and inflammation marker levels were correlated with measured glomerular filtration rate (GFR) in 128 pediatric RTx recipients over a median follow-up period of 10 years. METHODS Serum levels of erythropoietin (EPO), hepcidin-25, high-sensitivity C-reactive protein (CRP) (hsCRP) and interleukin-6 (IL-6) were analyzed by enzyme-linked immunosorbent assays, and GFR was analyzed by 51Cr-EDTA clearance. RESULTS The median levels of Hb (115 g/L), hsCRP (0.4 mg/L) and IL-6 (1.4 pg/mL) and the median erythrocyte sedimentation rate (ESR; 19 mm/h) remained stable after the first post-operative year. However, approximately half of the patients had a normocytic, normochromic anemia, and one-third had elevated levels of hsCRP (>1 mg/L) and ESR (>25 mm/h), indicating continuous low-grade inflammation. Low Hb levels preceded increased fibrosis in protocol biopsies taken at 1.5 and 3 years after transplantation and preceded decreased GFR by several years. Hb levels showed an inverse correlation with EPO levels (r = -0.206, p = 0.038) and ESR (r = -0.369, p < 0.001), but not with hepcidin-25, hsCRP or IL-6 levels. The levels of the major inflammatory markers IL-6 and hsCRP did not show a significant correlation with GFR at either the early maintenance phase or later. In the multivariable analysis, low Hb levels performed better than any other marker with respect to predicting concomitant and subsequent GFR. CONCLUSIONS Anemia, but not elevated inflammatory indices, was associated with poor concomitant and subsequent graft function during a 10-year follow-up in pediatric RTx patients.
Collapse
Affiliation(s)
- Jenni Miettinen
- Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
| | - Juuso Tainio
- Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Timo Jahnukainen
- Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Mikko Pakarinen
- Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Jouni Lauronen
- Histocompatibility Laboratory, Finnish Red Cross Blood Service, Helsinki, Finland
| | - Hannu Jalanko
- Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| |
Collapse
|
8
|
Bamgbola OF. Spectrum of anemia after kidney transplantation: pathophysiology and therapeutic implications. Clin Transplant 2016; 30:1185-1194. [DOI: 10.1111/ctr.12813] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/15/2016] [Indexed: 01/06/2023]
Affiliation(s)
- Oluwatoyin F. Bamgbola
- Division of Pediatric Nephrology; Downstate Medical Center; State University of New York; Brooklyn NY USA
| |
Collapse
|