title: Anemia has a negative impact on self-rated health in kidney transplant recipients with well-functioning grafts: findings from an 8-year follow-up study.
abstract: OBJECTIVE
  Anemia is a predictor of mortality and of self-rated health (SRH). However, studies on the relationship between SRH and changes in hemoglobin (Hb) value over time stratified by chronic kidney disease (CKD) stages are lacking. The aim is to explore whether a change in Hb-value over time associates with SRH at up to 8-year follow-up, stratified for CKD stages.
  
  
  METHODS
  A prospective study with a baseline measurement between the 3rd and 12th month after KT was performed on 337 consecutive patients. Demographic and clinical data were retrieved from medical records. CKD stages were estimated using the CKD-EPI formula and divided into two groups: CKD1-2 and CKD3-5. Generalized estimating equations (GEE) were performed to identify associations of SRH at follow-up in both CKD groups.
  
  
  RESULTS
  Male gender, new-onset diabetes mellitus after KT (NODAT), a decrease in estimated glomerular filtration rate (eGFR) and Hb-value over time contributed significantly to the GEE model on SRH at follow-up in CKD1-2. For SRH at follow-up in CKD3-5, older age, male gender and chronic renal allograft dysfunction (CRAD) contributed significantly to the GEE model.
  
  
  CONCLUSIONS
  At up to 8-year follow-up, male gender, NODAT, a decrease in eGFR and Hb-value over time are associated with poorer SRH in CKD1-2. In such patients, we suggest monitoring slight deteriorations in eGFR and Hb-values. In CKD3-5, higher age, male gender and higher presence of CRAD are associated with poorer SRH at up to 8-year follow-up. In these patients, adequate treatment would slow down CRAD progression.
authors.affiliation: Nephrology and Dialysis Centre, Fresenius Medical Care - Dialysis Services Slovakia, Tr. SNP 1, 040 11, Kosice, Slovakia. mamajern@gmail.com.|Faculty of Medicine, Graduate School Kosice Institute for Society and Health, Safarik University, Kosice, Slovakia. mamajern@gmail.com.
authors.forename: Maria
authors.initials: M
authors.lastname: Majernikova
authors.affiliation: Nephrology and Dialysis Centre, Fresenius Medical Care - Dialysis Services Slovakia, Tr. SNP 1, 040 11, Kosice, Slovakia.|Faculty of Medicine, Graduate School Kosice Institute for Society and Health, Safarik University, Kosice, Slovakia.|Department of Social Medicine, Faculty of Medicine, Institute of Public Health, Safarik University, Kosice, Slovakia.|Transplantation Department of the 1st Surgery Clinic, Faculty of Medicine, Safarik University, University Hospital, Kosice, Slovakia.
authors.forename: Jaroslav
authors.initials: J
authors.lastname: Rosenberger
authors.affiliation: Faculty of Medicine, Graduate School Kosice Institute for Society and Health, Safarik University, Kosice, Slovakia.
authors.forename: Lucia
authors.initials: L
authors.lastname: Prihodova
authors.affiliation: Medical Board Fresenius Medical Care, Bad Homburg, Germany.
authors.forename: Daniele
authors.initials: D
authors.lastname: Marcelli
authors.affiliation: Nephrology and Dialysis Centre, Fresenius Medical Care - Dialysis Services Slovakia, Tr. SNP 1, 040 11, Kosice, Slovakia.|Transplantation Department of the 1st Surgery Clinic, Faculty of Medicine, Safarik University, University Hospital, Kosice, Slovakia.
authors.forename: Robert
authors.initials: R
authors.lastname: Roland
authors.affiliation: Department of Community and Occupational Health, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands.
authors.forename: Johan W
authors.initials: JW
authors.lastname: Groothoff
authors.affiliation: Faculty of Medicine, Graduate School Kosice Institute for Society and Health, Safarik University, Kosice, Slovakia.|Department of Community and Occupational Health, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands.
authors.forename: Jitse P
authors.initials: JP
authors.lastname: van Dijk
mesh_terms: D000368:Aged; D000740:Anemia / Q000401:mortality / Q000503:physiopathology* / Q000523:psychology; D005260:Female; D005500:Follow-Up Studies; D006304:Health Status; D006305:Health Status Indicators; D006454:Hemoglobins / Q000032:analysis*; D006801:Humans; D016030:Kidney Transplantation / Q000523:psychology*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011788:Quality of Life / Q000523:psychology*; D051436:Renal Insufficiency, Chronic / Q000503:physiopathology* / Q000523:psychology / Q000601:surgery; D013995:Time
chemical_list: D006454:Hemoglobins
keywords: Anemia; Chronic kidney disease; Kidney transplantation; Longitudinal design; Self-rated health