Anemia in Kidney Transplants Without Erythropoietic Agents: Levels of Erythropoietin and Iron Parameters

Florit, Enrique; Hadad, F.; Cubillo, B. Rodriguez; Flor, J. C. De la; Valga, Francisco; Flores, Isabel; Romero, Natividad Calvo; Cecilio, Rosalía Valero San; Guzman, A. Barrientos; Fructuoso, Ana Sánchez

doi:10.1016/j.transproceed.2012.09.044

Cited by 7 publications

(8 citation statements)

References 9 publications

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“…, Florit et al . ). As for the underlying mechanisms, ANGII has been proposed to lower the renal O 2 supply (blood flow)/demand (tubular work) ratio, thus decreasing tissue P O2 .…”

Section: Discussionmentioning

confidence: 97%

Reduction in central venous pressure enhances erythropoietin synthesis: role of volume‐regulating hormones

et al. 2016

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“…, Florit et al . ). As for the underlying mechanisms, ANGII has been proposed to lower the renal O 2 supply (blood flow)/demand (tubular work) ratio, thus decreasing tissue P O2 .…”

Section: Discussionmentioning

confidence: 97%

Reduction in central venous pressure enhances erythropoietin synthesis: role of volume‐regulating hormones

et al. 2016

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“…Finally, beyond the first 3 months of transplant surgery, other causes of bone marrow depression may ensue . These include opportunistic viral infections and commonly prescribed agents such as sirolimus (SRL), cyclosporine (CsA), mycophenolate mofetil (MMF), cotrimoxazole, prednisolone, angiotensin modulators, and valganciclovir . Clues to anemia produced by drugs and/or viral infections are the presence of thrombocytopenia, neutropenia, and/or poor response to Fe treatment …”

Section: Early Post‐transplant Periodmentioning

confidence: 99%

“…Rather than intensity of immunosuppression, long duration of treatment with maintenance agents such as MMF, AZA, and SRL becomes of relative importance . In addition, onset of chronic graft injury may necessitate substitution with drugs having more hematotoxic profile (e.g., sirolimus) . New medications may be introduced to combat infectious complications (e.g., ribavirin for hepatitis C viremia) .…”

Section: Late Post‐transplant Phasementioning

confidence: 99%

“…Depending on the renal capacity for EPO synthesis, there are two ill‐defined groups of patients with late‐onset anemia . In a study of 23 adults, 90% of the patients with impaired graft function and anemia had low serum EPO (EPO deficiency), while 10% had an increase in serum EPO (bone marrow resistance) .…”

Section: Erythropoietin and Post‐transplant Anemiamentioning

confidence: 99%

“…Longer duration of treatment and larger EPO dose (1582 units/kg) were required for those with the bone marrow resistance . Predisposing factors for anemia due to EPO resistance were drug toxicity (e.g., sirolimus), chronic myelofibrosis, chronic hemolysis, and poor nutrition . Due to the common occurrence of these variables, there was a 10‐fold greater incidence of anemia in transplant recipients with similar grade of creatinine clearance compared with patients with CKD …”

Section: Erythropoietin and Post‐transplant Anemiamentioning

confidence: 99%

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Spectrum of anemia after kidney transplantation: pathophysiology and therapeutic implications

Bamgbola

2016

Clinical Transplantation

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The prevalence of anemia in the first month after transplant is 70%-80%. The rate declines to 30%-40% at 3 months and 20% by 12 months. Its occurrence is influenced by the quality of the transplanted organ, bone marrow regenerative capacity, amount of surgical blood loss, and increased iron recycling. There is also a blunted response by oxidative inflammation to the effectiveness of supranormal levels of erythropoietin (EPO) release during ischemic-reperfusion allograft injury. The prevalence rate of late-onset post-transplant anemia (PTA) is 30%-50%. This category of patients falls into two ill-defined groups: (i) those with impaired renal capacity for EPO synthesis and (ii) those with bone marrow resistance. Given the difference in pathophysiology, the current KDIGO guideline that adopts uniform therapeutic approach for the two groups may be inappropriate. Comorbidity due to iron deficiency is common. Anemia is predictive of cardiovascular morbidity and shorter graft survival. Perhaps due to concern for the safe use of EPO stimulating agent (ESA) to correct anemia, there is often inadequate treatment of late-onset PTA. However, universal application of ESA may be harmful. Therefore, clinical trials are needed to define parameters for selecting patients (e.g., EPO assay) that will benefit the most from therapy for anemia.

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Regulation of Red Blood Cell Volume with Exercise Training

Montero

Lundby

2018

Comprehensive Physiology

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Hypervolemia is a hallmark of endurance training (ET) and manifests by similar elevations in plasma (PV) and red blood cell volume (RBCV) so that hematocrit largely remains unaltered following weeks/months of training. While the mechanisms facilitating PV expansion with ET have been previously reviewed extensively this is not the case for RBCV. Endurance champions may have 40% more RBCV than controls and RBCV may increase up to 10% following months of regular exercise training in healthy individuals. Such adaptations are the main factor leading to concomitant changes in maximal oxygen uptake. The increase in RBCV is preceded by that of PV after few ET sessions, which in turn transiently decreases the hematocrit. The “critmeter” theory suggests that O 2 sensors located within the juxtamedullary apparatus regulate the hematocrit via modulation of renal erythropoietin (EPO) production according to arterial O 2 content‐dependent changes in tissue O 2 pressure. Hence, the initial decrease in hematocrit can be considered as a primary mechanism facilitating RBCV expansion with ET. Furthermore, after a single endurance exercise bout blood volume‐regulating hormones ANGII and VPN increase transiently. Both stimulate renal EPO production. Catecholamines and cortisol, stress hormones acutely increased by endurance exercise, may facilitate the release of red blood cells from the bone marrow, thus possibly contributing to ET‐induced erythropoiesis. These and other endocrine effects could be enhanced by the hyperplasia of the hematopoietic bone marrow observed in endurance athletes. © 2019 American Physiological Society. Compr Physiol 9:149‐164, 2019.

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Anemia in Kidney Transplants Without Erythropoietic Agents: Levels of Erythropoietin and Iron Parameters

Cited by 7 publications

References 9 publications

Reduction in central venous pressure enhances erythropoietin synthesis: role of volume‐regulating hormones

Reduction in central venous pressure enhances erythropoietin synthesis: role of volume‐regulating hormones

Spectrum of anemia after kidney transplantation: pathophysiology and therapeutic implications

Regulation of Red Blood Cell Volume with Exercise Training

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