title: Anemia is a predictor of graft loss but not cardiovascular events and all-cause mortality in renal transplant recipients: follow-up data from the ALERT study.
abstract: BACKGROUND
  It is well established that post-transplantation anemia (PTA) in renal transplant recipients (RTRs) is associated with reduced graft survival. However, there is an uncertainty of the effect of PTA on cardiovascular events and all-cause mortality. We examined prospectively in a large cohort of erythropoietin-naive patients the effects of PTA on cardiovascular morbidity, patient survival, and graft survival.
  
  
  METHODS
  A prospective cohort study of RTRs (n = 2102) included in the ALERT study. Cox regression models were used to evaluate the impact of PTA on study endpoints: first occurrence of a major adverse cardiac event, all-cause death, and the incidence of death-censored graft loss. Mean follow-up was 6.7 yr. All endpoints were adjudicated by an independent endpoint committee.
  
  
  RESULTS
  Twenty-nine percent of women and 30% of men were anemic. Hemoglobin levels were not associated with any effect on cardiovascular morbidity and mortality (HR 0.97 [0.90-1.05] per g/dL, p = 0.48) or all-cause death (HR 0.96 [0.90-1.03] per g/dL, p = 0.24) after extensive multivariate adjustments for clinical and demographic factors. Hemoglobin levels were negatively associated with graft loss (HR 0.86 [0.80-0.92] per g/dL, p < 0.001).
  
  
  CONCLUSIONS
  PTA was not associated with an increased incidence of cardiovascular morbidity and mortality or all-cause mortality.
authors.affiliation: Department of Nephrology, Aalborg University Hospital, Aalborg, Denmark.
authors.forename: Patrick
authors.initials: P
authors.lastname: Schjelderup
authors.forename: Dag Olav
authors.initials: DO
authors.lastname: Dahle
authors.forename: Hallvard
authors.initials: H
authors.lastname: Holdaas
authors.forename: Geir
authors.initials: G
authors.lastname: Mjøen
authors.forename: Gudrun
authors.initials: G
authors.lastname: Nordby
authors.forename: Sadollah
authors.initials: S
authors.lastname: Abedini
authors.forename: Alan
authors.initials: A
authors.lastname: Jardine
authors.forename: Bengt
authors.initials: B
authors.lastname: Fellström
authors.forename: My
authors.initials: M
authors.lastname: Svensson
mesh_terms: D000328:Adult; D000740:Anemia / Q000175:diagnosis* / Q000401:mortality; D002318:Cardiovascular Diseases / Q000401:mortality*; D002423:Cause of Death; D004311:Double-Blind Method; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D006801:Humans; D007676:Kidney Failure, Chronic / Q000175:diagnosis* / Q000401:mortality; D007677:Kidney Function Tests; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors; D015996:Survival Rate
keywords: anemia; chronic kidney disease; graft survival; kidney transplantation; mortality