title: Level of renal function and serum erythropoietin levels independently predict anaemia post-renal transplantation.
abstract: BACKGROUND
  Post-renal transplant anaemia is a potentially reversible cardiovascular risk factor. Graft function, immunosuppressive agents and inhibition of the renin-angiotensin system have been implicated in its aetiology. The evaluation of erythropoietin (EPO) levels may contribute to understanding the relative contributions of these factors.
  
  
  METHODS
  Two-hundred and seven renal transplant recipients attending the Belfast City Hospital were studied. Clinical and laboratory data were extracted from the medical records and laboratory systems.
  
  
  RESULTS
  Of the 207 patients (126 male), 47 (22.7%) were found to be anaemic (males, haemoglobin (Hb)<12 g/dl, females Hb<11 g/dl). The anaemic group had a significantly higher mean serum creatinine level (162.8 micromol/l vs 131.0 micromol/l, P<0.001) and lower mean estimated glomerular filtration rate (eGFR) (41.5 ml/min vs 54.9 ml/min, P<0.001) than the non-anaemic group. Individual immunosuppressive regimens were comparable between those with and those without anaemia. Angiotensin converting enzyme inhibitor (ACE-I) or angiotensin receptor blocker (ARB) administration was not more prevalent in those with anaemia compared with those without (36.2 vs 38.8%, P=0.88). There was a significant inverse correlation between Hb levels and serum EPO levels (R=-0.29, P<0.001), but not between EPO levels and eGFR (R=0.02, P=0.74). Higher EPO levels were predictive of anaemia, independent of eGFR in multivariate analysis.
  
  
  CONCLUSIONS
  Anaemia is common in post-renal transplant patients. The levels of renal function and serum EPO and not immunosuppressive regimens or ACE-I/ARB use, are strong and independent predictors of anaemia.
authors.affiliation: Regional Nephrology Unit, Belfast City Hospital, Lisburn Road, Belfast BT9 7AB, Northern Ireland, UK. kimsinnamon@msn.com
authors.forename: Kim T
authors.initials: KT
authors.lastname: Sinnamon
authors.forename: Aisling E
authors.initials: AE
authors.lastname: Courtney
authors.forename: A Peter
authors.initials: AP
authors.lastname: Maxwell
authors.forename: Peter T
authors.initials: PT
authors.lastname: McNamee
authors.forename: Geraldine
authors.initials: G
authors.lastname: Savage
authors.forename: Damian G
authors.initials: DG
authors.lastname: Fogarty
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000740:Anemia / Q000209:etiology*; D001379:Azathioprine / Q000627:therapeutic use; D004921:Erythropoietin / Q000097:blood*; D005260:Female; D005919:Glomerular Filtration Rate; D006454:Hemoglobins / Q000378:metabolism; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007668:Kidney / Q000503:physiopathology*; D007674:Kidney Diseases / Q000097:blood / Q000503:physiopathology* / Q000601:surgery*; D016030:Kidney Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D009173:Mycophenolic Acid / Q000031:analogs & derivatives / Q000627:therapeutic use; D011182:Postoperative Care; D011237:Predictive Value of Tests
chemical_list: D006454:Hemoglobins; D007166:Immunosuppressive Agents; D004921:Erythropoietin; D009173:Mycophenolic Acid; D001379:Azathioprine