Anemia and Erythrocytosis in patients after kidney transplantation

Małyszko, Jolanta; Oberbauer, Rainer; Watschinger, Bruno

doi:10.1111/j.1432-2277.2012.01513.x

Cited by 48 publications

(49 citation statements)

References 105 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Anemia is a well‐known complication of CKD, yet PTA has received less attention and its causes are not completely understood . Data on PTA in pediatric kidney graft recipients are scarce .…”

Section: Discussionmentioning

confidence: 99%

Anemia and markers of erythropoiesis in pediatric kidney transplant recipients compared to children with chronic renal failure

Krause

Davidovits

Tamary

et al. 2016

Pediatric Transplantation

View full text Add to dashboard Cite

PTA and anemia of CKD share a similar pathogenesis. However, PTA may be disproportionate to the reduction in the GFR. Data relating to the mechanism of PTA are scarce. We evaluated the erythropoiesis parameters in pediatric kidney recipients compared to children with CKD. A total of 100 patients (54 post-kidney TX, 46 with CKD) were enrolled in the single-center cohort study. GFR was found to be significantly lower in the CKD group (49.7±22.4 vs 72.9±28.5 mL/min/1.73 m², P<.001); anemia was significantly more common in the TX patients (52% vs 41.3%, P<.001). Iron transferrin saturation and serum ferritin levels were lower in the CKD patients. In both groups, hemoglobin Z scores significantly correlated with GFR (R=.31, P=.07). This correlation was more prominent in the CKD group (R=.43, P=.008) compared to the TX group (R=.31, P=.04). Anemia was significantly more common in the TX patients than in the CKD patients despite a better GFR. The higher prevalence of anemia in the TX group could not be explained by an iron deficiency or reduced EPO production. We speculate that immunosuppressive therapy together with resistance to EPO may play a role in the pathogenesis of post-transplantation anemia.

show abstract

Section: Discussionmentioning

confidence: 99%

Anemia and markers of erythropoiesis in pediatric kidney transplant recipients compared to children with chronic renal failure

Krause

Davidovits

Tamary

et al. 2016

Pediatric Transplantation

View full text Add to dashboard Cite

show abstract

“…Since tacrolimus is a low-extraction-ratio drug [10], whole blood concentrations are expected to increase in proportion to erythrocyte binding (proportional to hematocrit), while the unbound, therapeutically active concentration remains unchanged. At the time of kidney transplant, hematocrit is generally low, and it usually increases during the first months after transplantation as the recipients recover from kidney failure and erythrocyte production normalizes [11]. Because changes in hematocrit are expected to change the concentration of bound tacrolimus without modifying the unbound concentration [9], this trend should not be interpreted as the need for dose adjustment.…”

Section: Introductionmentioning

confidence: 99%

Importance of hematocrit for a tacrolimus target concentration strategy

Størset

Holford

Midtvedt

et al. 2013

Eur J Clin Pharmacol

104

121

View full text Add to dashboard Cite

PurposeTo identify patient characteristics that influence tacrolimus individual dose requirement in kidney transplant recipients.MethodsData on forty-four 12-h pharmacokinetic profiles from 29 patients and trough concentrations in 44 patients measured during the first 70 days after transplantation (1,546 tacrolimus whole blood concentrations) were analyzed. Population pharmacokinetic modeling was performed using NONMEM 7.2®.ResultsStandardization of tacrolimus whole blood concentrations to a hematocrit value of 45 % improved the model fit significantly (p < 0.001). Fat-free mass was the best body size metric to predict tacrolimus clearance and volume of distribution. Bioavailability was 49 % lower in expressers of cytochrome P450 3A5 (CYP3A5) than in CYP3A5 nonexpressers. Younger females (<40 years) showed a 35 % lower bioavailability than younger males. Bioavailability increased with age for both males and females towards a common value at age >55 years that was 47 % higher than the male value at age <40 years. Bioavailability was highest immediately after transplantation, decreasing steeply thereafter to reach its nadir at day 5, following which it increased during the next 55 days towards an asymptotic value that was 28 % higher than that on day 5.ConclusionsHematocrit predicts variability in tacrolimus whole blood concentrations but is not expected to influence unbound (therapeutically active) concentrations. Fat-free mass, CYP3A5 genotype, sex, age and time after transplant influence the tacrolimus individual dose requirement. Because hematocrit is highly variable in kidney transplant patients and increases substantially after kidney transplantation, hematocrit is a key factor in the interpretation of tacrolimus whole blood concentrations.Electronic supplementary materialThe online version of this article (doi:10.1007/s00228-013-1584-7) contains supplementary material, which is available to authorized users.

show abstract

“…Persistent erythropoietin secretion from the diseased and chronically ischemic native kidneys does not conform to the normal feedback. However, erythropoietin levels in most PTE patients still remain within the "normal range," indicating that erythrocytosis finally ensues by the contributory action of additional growth factors on erythroid progenitors, such as angiotensin II, androgens, sSCF and insulin-like growth factor 1 (IGF-1) (55)(56)(57)59). 25% of all patients with PTE may see resolution without any treatment.…”

Section: Erythrocytosismentioning

confidence: 99%

“…PTE appears predominantly in patients without native kidney nephrectomy and in those, who had an adequate erythropoiesis prior to transplantation, as evidenced by no or limited use of ESA while on dialysis (54). The pathogenesis of PTE is not well understood and multiple hormonal systems as well as growth factors such as erythropoetin, Insulin-like growth factor-1, serum-soluble stem cell factor (sSCF), renninangiotensin system and endogenous androgens have been implicated (2,(55)(56)(57)(58)(59). Endogenous erythropoietin appears to play the central role.…”

Section: Erythrocytosismentioning

confidence: 99%