Renal Insufficiency May Partly Explain Chronic Anemia in Patients Awaiting Liver Transplantation

Abstract

In patients with cirrhosis, anemia is common and is likely to be multifactorial, including decreased erythrocyte production, sequestration due to hypersplenism, hemolysis, and increased blood loss from gastrointestinal bleeding. Renal dysfunction is also common in liver disease and this may also cause anemia. However, an association between anemia and renal dysfunction has not been reported in patients with cirrhosis. Our objective was to determine whether anemia in cirrhotic patients is independently related to renal dysfunction. We conducted a retrospective chart review of patients in our institution listed for liver transplantation. We collected simultaneous data on age, hemoglobin, creatinine, albumin, liver enzymes, prothrombin time, and bilirubin. We excluded patients who were hospitalized or deceased to avoid confounding variables. Two hundred eighty-six (female n = 130) patients with a mean age of 52.8 +/- 9.7 (range, 18-73) years were studied. Renal dysfunction (creatinine > 1.2 mg/dL) was present in 55 (19%) patients, and anemia (hemoglobin < 12 g/dL) was seen in 115 (40%) patients. Anemia was more common in patients with renal dysfunction (64 versus 34%; P < 0.001) compared to those with normal renal function. Creatinine, prothrombin time, and bilirubin showed an inverse relationship (all P's < 0.001) with hemoglobin, and albumin showed a positive correlation with hemoglobin (P < 0.001). Multivariate analysis showed that creatinine (OR, 2.4; 95% CI, 1.05-5.3; P = 0.038), prothrombin time (P = 0.026), bilirubin (P = 0.035), and albumin (P = 0.001) were independent predictors of anemia. Renal dysfunction is an important cause of anemia in patients with cirrhosis. The role of erythropoietin in the management of anemia in patients with cirrhosis and renal dysfunction should be explored in prospective studies.

HCV‐related advanced fibrosis/cirrhosis: randomized controlled trial of pegylated interferon α‐2a and ribavirin

“…RBV is excreted mainly in urine [17–19] and its elimination depends on the glomerular filtration rate [20,21]. In cirrhotics, kidney function was impaired in 1/3 [22], and may be impaired despite a normal serum creatinine [23], and mild anaemia is common [24]. Thus, cirrhotics are at risk of RBV accumulation and vulnerable to haemolytic anaemia, a common dose‐dependent side effect of RBV [25].…”

Predictive Factors for Anemia Six and Twelve Months After Orthotopic Liver Transplantation

“…Other causes of anemia in cirrhotic patients include reduced survival of red blood cells (13); hemolysis secondary to an enlarged spleen, which sequesters and destroys blood cells and leads to macro-normoblastic bone marrow (14); and renal insufficiency (15). Patt et al (16) reported that independent predictors of anemia (Hb Ͻ12 g/dL) in patients awaiting liver transplantation include serum creatinine (Ͼ12 mg/L), prothrombin time, and bilirubin and albumin levels. Finally, it seems that serum Epo values in cirrhotic patients are only detectable when Hb is Ͻ12 g/dL.…”

Fatigue and physical activity levels in patients with liver cirrhosis

“…In a study of patients with liver cirrhosis by Patt et al. (2004), 115 of 286 patients (40%) suffered from anaemia (haemoglobin <12 g/dl).…”