Anemia after kidney transplantation; its prevalence, risk factors, and independent association with graft and patient survival: a time-varying analysis.

Introduction. Posttransplant anemia and its association with transplant outcomes have not been properly studied. Methods. We examined 530 renal allograft recipients transplanted at our center and followed up for 31.0 +/- 14.1 months. Hemoglobin (Hb), serum bicarbonate, and creatinine; use of erythropoiesis-stimulating agent (ESA) and iron; and immunosuppressive regimen data were obtained at multiple time points during 24-month posttransplant. Results. The overall prevalence of anemia was 89.4% at the time of transplant, dropping to 49.2% at 1 year and 44.3% at 2 years. ESA use decreased from 25.6% at 1 month to 8.23% at 24 months, only in 30.9% to 51.2% with severe anemia; 21.0% to 29.2% received iron supplements. Factors independently predictive of Hb included male gender (beta = 0.64, P<0.001, confidence interval [CI]: 0.45-0.82), estimated glomerular filtration rate (beta = 0.21 per 10 mL/min/1.73 m(2), P<0.001; CI: 0.16-0.27), bicarbonate (beta = 0.4 per 10 mmol/L increase, P<0.001; CI: 0.31-0.85), using angiotensin-converting enzyme inhibitor/angiotensin receptor blocker (beta = 0.36, P<0.001; CI: 0.16-0.55), African American race (beta = -0.34, P=0.001, CI: -0.54 to -0.14), iron (beta = -0.28, P=0.003, CI: -0.47 to -0.09) and ESA use (beta = -0.73, P更多