Background
Methods
Study design and patients
Definitions
Anemia
Anemia severity
Causes of anemia
Iron deficiency
Vitamin B12 deficiency
Data collection
Outcomes
Statistical analysis
Results
Patients’ characteristics
Anemia | No anemia (n = 727) | Total (n = 1139) | |||
---|---|---|---|---|---|
Mild (n = 278) | Severe (n = 134) | All (n = 412) | |||
Mean age at transplant (mean ± SD) | 50.7 ± 15.8 | 45.9 ± 16.3 | 49.1 ± 16.1 | 47.5 ± 14.1 | 48.1 ± 14.9 |
Male sex n (%) | 60 (21.6) | 81 (60.4) | 141 (34.2) | 236 (32.5) | 377 (33.1%) |
BMI (Kg/m^2) | 26.7 ± 5 | 24.7 ± 6 | 26.1 ± 5.4 | 26 ± 4.8 | 26 ± 5 |
HCV positive n (%) | 3 (1.1) | 3 (2.4) | 6 (1.6) | 33 (4.5) | 39 (3.5) |
HBV positive n (%) | 4 (1.5) | 4 (3.2) | 8 (2.1) | 14 (1.9) | 22 (2) |
Donor CMV positive n (%) | 202 (77.1) | 93 (74.4) | 295 (76.2) | 592 (81.4) | 887 (79.6) |
Recipient CMV positive n (%) | 220 (84) | 111 (88.8) | 331 (85.5) | 647 (89) | 978 (87.8) |
Original renal disease | |||||
Glomerulonephritis | 64 (20.9) | 42 (28.2) | 106 (23.3) | 227 (29.9) | 333 (26.6) |
CAKUT | 37 (12.1) | 22 (17.5) | 59 (13) | 67 (8.4) | 126 (10.1) |
Diabetic nephropathy | 72 (23.5) | 36 (24.2) | 108 (23.7) | 132 (16.6) | 240 (19.2) |
Polycystic kidney disease (PKD) | 29 (9.5) | 12 (8.1) | 41 (9) | 102 (12.8) | 143 (11.4) |
Genetic disease (excluding PKD) | 11 (3.6) | 4 (2.7) | 15 (3.3) | 18 (2.3) | 33 (2.6) |
Chronic interstitial nephritis | 8 (2.6) | 4 (2.7) | 12 (2.6) | 13 (1.6) | 25 (2) |
No diagnosis/unknown | 85 (27.8) | 29 (19.5) | 114 (25.1) | 238 (29.9) | 352 (28.1) |
Length of hospitalization (ln, days) | 2.4 ± 0.5 | 2.5 ± 0.6 | 2.4 ± 0.5 | 2.5 ± 0.5 | 2.4 ± 0.5 |
Mean duration of dialysis (months) | 32.8 ± 37.3 | 36.8 ± 45.7 | 34.1 ± 40.2 | 34.3 ± 38.4 | 34.2 ± 39 |
Previous renal transplantation n (%) | |||||
0 | 255 (91.7) | 110 (82.1) | 365 (88.6) | 643 (88.4) | 1008 (88.5) |
≥1 | 23 (8.3) | 24 (17.9) | 47 (11.4) | 84 (11.6) | 131 (11.5) |
Living donor (%) | 167 (60.1) | 74 (55.2) | 241 (58.5) | 427 (58.7) | 668 (58.6) |
Mean donor age (years) | 48.9 ± 14.3 | 47 ± 14.6 | 48.3 ± 14.4 | 42.66 ± 13.9 | 44.7 ± 14.3 |
HLA Mismatch (mean ± SD) | 4.2 ± 1.6 | 4.2 ± 1.5 | 4.2 ± 1.6 | 4 ± 1.6 | 4.1 ± 1.6 |
Mean cold ischemia time (hours) | 5:06 ± 6:31 | 5:09 ± 7:08 | 5:07 ± 6:42 | 6:16 ± 7.56 | 5:52 ± 7.33 |
PRA > 10% (%) | 31 (11.2) | 22 (16.4) | 53 (12.9) | 79 (10.9) | 132 (11.6) |
Delayed graft function n (%) | 48 (17.3) | 31 (23.1) | 79 (19.2) | 124 (17.1) | 203 (17.8) |
Co-morbidities n (%) | |||||
Diabetes | 96 (34.5) | 44 (32.8) | 140 (34) | 166 (22.8) | 306 (26.9) |
Hypertension | 218 (86.2) | 100 (82.6) | 318 (85) | 610 (87.3) | 928 (86.5) |
Cardiovascular | 76 (27.3) | 30 (22.4) | 106 (25.7) | 123 (16.9) | 229 (20.1) |
Laboratory workup at 6 months: | |||||
eGFR (ml/min/1.73 m^2) | 55.8 ± 19.6 | 52.3 ± 22.7 | 54.7 ± 20.7 | 63.3 ± 19.5 | 60.2 ± 20.3 |
Mean Hemoglobin (g/dL) | 12.1 ± 1.1 | 10.15 ± 1.5 | 11.7 ± 1.4 | 13.4 ± 1.7 | 12.8 ± 1.8 |
Hematocrit (%) | 37.1 ± 3.6 | 33.9 ± 4.7 | 36.1 ± 4.3 | 41.1 ± 5.2 | 39.2 ± 5.4 |
MCV (fL) | 87.7 ± 6.4 | 87.2 ± 7.9 | 87.5 ± 6.9 | 88.3 ± 5.8 | 88 ± 6.3 |
RDW (%) | 14.5 ± 1.5 | 14.7 ± 1.5 | 14.6 ± 1.5 | 14.3 ± 1.2 | 14.4 ± 1.3 |
Platelets (X10^3/microL) | 196.5 ± 68.1 | 229.8 ± 90.5 | 207.3 ± 77.5 | 208.7 ± 65.4 | 208.2 ± 70.1 |
Leukocytes (X10^3/microL) | 6.4 ± 2.2 | 6.7 ± 3.4 | 6.5 ± 2.6 | 7.4 ± 2.6 | 7 ± 2.7 |
Iron (microgram/dL) | 71.2 ± 34.4 | 63.7 ± 35.9 | 68.1 ± 35.2 | 77.6 ± 36.9 | 72.9 ± 36.4 |
Transferrin (mg/dL) | 219.2 ± 42.6 | 197.8 ± 59.1 | 210.3 ± 51.1 | 221.3 ± 49.9 | 215.8 ± 50.8 |
Transferrin saturation (%) | 23.6 ± 13 | 24.8 ± 15.7 | 24.1 ± 14.2 | 25.7 ± 14.6 | 24.9 ± 14.4 |
Ferritin (ng/mL) | 370.2 ± 393.2 | 461.4 ± 537 | 408.6 ± 460.1 | 388.8 ± 458.5 | 399.5 ± 458.8 |
Albumin n (%) | 4.04 ± 0.5 | 4.02 ± 0.5 | 4.04 ± 0.5 | 4.15 ± 0.39 | 4.1 ± 0.45 |
Folic acid (nmol/L) | 15.3 ± 9.7 | 15.9 ± 12.1 | 15.5 ± 10.6 | 16.7 ± 9.9 | 16.1 ± 10.2 |
Vitamin B12 (pmol/L) | 474.7 ± 299.9 | 487.9 ± 284.1 | 479 ± 294.1 | 413.9 ± 213 | 16.1 ± 10.2 |
FK506 level (ng/ml) | 8.4 ± 2.6 | 8.4 ± 3 | 8.4 ± 2.8 | 8.8 ± 3 | 8.7 ± 2.9 |
Immunosuppressive drugs | |||||
Tacrolimus | 245 (93.5) | 110 (88) | 355 (91.7) | 661 (90.9) | 1016 (91.2) |
Cyclosporine | 8 (3.1) | 9 (7.2) | 17 (4.4) | 31 (4.3) | 48 (4.3) |
mTOR inhibitors | 6 (2.3) | 4 (3.2) | 10 (2.6) | 22 (3) | 32 (2.9) |
Other | 3 (1.1) | 2 (1.6) | 5 (1.3) | 13 (1.8) | 18 (1.6) |
Erythropoietin treatment (%) | 7 (2.5) | 8 (5.9) | 15 (3.6) | 0 (0) | 15 (1.3) |
Causes | Patients n (% of anemic patients) | Events n (% of anemia events) |
---|---|---|
Nutritional deficiencies | ||
Iron deficiency | 143 (34.7) | 157 (31.4) |
Vitamin B12 | 98 (23.8) | 105 (21) |
Folic acid | 41 (9.9) | 43 (8.6) |
Acute rejection | 17 (4.1) | 22 (4.4) |
Acute kidney injury | 47 (11.4) | 48 (9.6) |
Infection | ||
Urinary tract infection | 32 (7.8) | 33 (6.6) |
Pulmonarya | 11 (2.7) | 11 (2.2) |
Skinb | 11 (2.7) | 11 (2.2) |
Miscellaneousc | 11 (2.7) | 11 (2.2) |
BK Virus | 26 (6.3) | 31 (6.2) |
CMV viremia | 16 (3.9) | 16 (3.2) |
Herpes zoster | 4 (1) | 4 (0.8) |
B19 Parvovirus | 1 (0.2) | 1 (0.2) |
Hematological | 12 (2.9) | 15 (3) |
Thalassemia trait | 5 (1.2) | 6 (1.2) |
PTLD | 2 (0.5) | 3 (0.6) |
Miscellaneousd | 5 (1.2) | 6 (1.2) |
Bleeding | 39 (9.5) | 39 (7.8) |
Peri-procedural | 20 (4.8) | 20 (4) |
Monthly menstruation | 11 (2.7) | 11 (2.2) |
Miscellaneouse | 8 (1.9) | 8 (1.6) |
Outcomes
Univariate | Multivariate | ||||||
---|---|---|---|---|---|---|---|
HR | 95% CI | P value | HR | 95% CI | P value | ||
Presence of anemia | Early | 3.64 | 2.34–5.66 | < 0.001 | 2.94 | 1.85–4.66 | < 0.001 |
Late | 1.57 | 1.09–2.26 | 0.015 | 1.44 | 0.97–2.13 | 0.074 | |
Severity of anemia | |||||||
Mild (Hb > 11 g/dL) | Early | 1.89 | 1.07–3.31 | 0.027 | 1.42 | 0.79–2.54 | 0.244 |
Late | 1.5 | 0.99–2.27 | 0.056 | 1.15 | 0.6–2.17 | 0.327 | |
Severe (Hb < 11 g/dL) | Early | 8.01 | 4.92–13.04 | < 0.001 | 6.26 | 3.74–10.5 | < 0.001 |
Late | 1.79 | 0.98–3.25 | 0.058 | 1.65 | 0.88–3.11 | 0.121 | |
Causes of anemia | |||||||
Acute rejection and/or acute kidney injury | Early | 12.3 | 7.2–21.0 | < 0.001 | 9.32 | 5.3–16.41 | < 0.001 |
Late | 2.32 | 1.13–4.75 | 0.022 | 2.06 | 0.97–4.39 | 0.061 | |
Infection | Early | 5.02 | 2.58–9.78 | < 0.001 | 3.99 | 2.01–7.95 | < 0.001 |
Late | 1.42 | 0.66–3.06 | 0.365 | 1.26 | 0.57–2.79 | 0.564 | |
Nutritional deficiencies | Early | 3.12 | 1.10–8.85 | 0.032 | 3.07 | 0.93–10.17 | 0.067 |
Late | 0.67 | 0.09–4.74 | 0.694 | 1.04 | 0.142–7.56 | 0.971 | |
Miscellaneous | Early | 2.43 | 1.22–4.83 | 0.012 | 1.82 | 0.85–3.48 | 0.133 |
Late | 1.75 | 0.96–3.2 | 0.068 | 1.44 | 0.76–2.7 | 0.263 | |
No reason found | Early | 0.65 | 0.197–2.11 | 0.467 | 0.59 | 0.18–1.94 | 0.383 |
Late | 1.38 | 0.77–2.47 | 0.281 | 1.29 | 0.7–2.37 | 0.415 |
Univariate | Multivariate | ||||||
---|---|---|---|---|---|---|---|
HR | 95% CI | P value | HR | 95% CI | P value | ||
Presence of anemia | Early | 4.06 | 2.17–7.57 | < 0.001 | 3.15 | 1.63–6.08 | 0.001 |
Late | 2.17 | 1.33–3.55 | 0.002 | 1.853 | 1.09–3.16 | 0.024 | |
Severity of anemia | |||||||
Mild (Hb > 11 g/dL) | Early | 1.76 | 0.77–4.03 | 0.179 | 1.35 | 0.56–3.25 | 0.5 |
Late | 2 | 1.14–3.5 | 0.015 | 1.66 | 0.91–3.01 | 0.096 | |
Severe (Hb < 11 g/dL) | Early | 9.78 | 5.0–19.13 | < 0.001 | 7.6 | 3.69–15.65 | < 0.001 |
Late | 2.65 | 1.25–5.64 | 0.011 | 2.61 | 1.15–5.92 | 0.021 | |
Causes of anemia | |||||||
Acute rejection and/or acute kidney injury | Early | 18.18 | 9.15–32.32 | < 0.001 | 12.94 | 6.14–27.28 | < 0.001 |
Late | 3.93 | 1.68–9.29 | 0.002 | 4.14 | 1.64–10.45 | 0.003 | |
Infection | Early | 3.47 | 1.15–10.47 | 0.027 | 3.01 | 0.97–9.33 | 0.056 |
Late | 1.36 | 0.42–4.39 | 0.603 | 1.09 | 0.33–3.64 | 0.885 | |
Nutritional deficiencies | Early | 3.25 | 0.74–14.14 | 0.117 | 1.63 | 0.21–12.51 | 0.636 |
Late | 1.47 | 0.2–10.75 | 0.703 | 1.88 | 0.25–14.13 | 0.538 | |
Miscellaneous | Early | 2.75 | 1.07–7.1 | 0.036 | 2.14 | 0.81–5.65 | 0.125 |
Late | 2.57 | 1.2–5.49 | 0.015 | 1.91 | 0.86–4.23 | 0.11 | |
No reason found | Earlya | ||||||
Late | 1.75 | 0.79-3.88 | 0.17 | 1.58 | 0.69–3.64 | 0.28 |
Univariate | Multivariate | ||||||
---|---|---|---|---|---|---|---|
HR | 95% CI | P value | HR | 95% CI | P value | ||
Presence of anemia | Early | 3.24 | 1.73–6.08 | < 0.001 | 2.27 | 1.17–4.4 | 0.015 |
Late | 1.1 | 0.63–1.92 | 0.735 | 0.8 | 0.44–1.47 | 0.469 | |
Severity of anemia | |||||||
Mild (Hb > 11 g/dL) | Early | 1.11 | 0.93–4.31 | 0.077 | 1.49 | 0.67–3.32 | 0.327 |
Late | 1.11 | 0.59–2.07 | 0.75 | 0.94 | 0.48–1.86 | 0.862 | |
Severe (Hb < 11 g/dL) | Early | 6.36 | 3.1–13.03 | < 0.001 | 5.42 | 2.51–11.68 | < 0.001 |
Late | 1.09 | 0.39–2.99 | 0.871 | 0.97 | 0.32–2.93 | 0.962 | |
Causes of anemia | |||||||
Acute rejection and/or acute kidney injury | Early | 6.88 | 2.83–16.76 | < 0.001 | 4.49 | 1.77–11.34 | 0.002 |
Late | 1.04 | 0.26–4.26 | 0.954 | 0.53 | 0.12–2.31 | 0.41 | |
Infection | Early | 6.45 | 2.76–15.91 | < 0.001 | 4.27 | 1.77–10.25 | 0.001 |
Late | 1.48 | 0.54–4.08 | 0.444 | 1.16 | 0.40–3.36 | 0.779 | |
Nutritional deficiencies | Early | 2.99 | 0.69–13.05 | 0.143 | 4.03 | 0.9–17.99 | 0.068 |
Latea | |||||||
Miscellaneous | Early | 2.12 | 0.78–5.79 | 0.142 | 1.23 | 0.44–3.47 | 0.693 |
Late | 1.08 | 0.39–2.99 | 0.88 | 0.89 | 0.3–2.61 | 0.834 | |
No reason found | Early | 1.24 | 0.36–4.26 | 0.731 | 0.91 | 0.26–3.21 | 0.879 |
Late | 1.1 | 0.47–2.6 | 0.828 | 0.86 | 0.35–2.08 | 0.733 |