title: Pre-Transplant Erythropoiesis-Stimulating Agent Hypo-Responsiveness and Post-Transplant Anemia.
abstract: BACKGROUND
  At the time of kidney transplantation (KT), almost all patients have anemia caused by low levels of endogenous erythropoietin (EPO), along with several other factors. After KT, anemia improves because of secretion of EPO from the allograft. But some recipients have persistent anemia. Whether or not erythropoiesis-stimulating agent (ESA) hypo-responsiveness before KT affects post-transplant anemia (PTA) remains unknown.
  
  
  METHODS
  Sixty-eight patients received KT between January 2007 and July 2012 through the Department of Urology at Kobe University Hospital, and 35 of these patients were enrolled. Exclusion criteria included age <18 years, unknown ESA dosage at transplantation, ESA start within 1 year after transplantation, and other criteria. We evaluated post-transplant hemoglobin (Hb) levels from the pre-transplant ESA responsive index (ERI): pre-transplant ESA dosage/Hb × body weight at 1 year after transplantation.
  
  
  RESULTS
  The mean (± SD) Hb of all patients rose from 11.3 ± 1.0 mg/dL to 12.7 ± 1.4 mg/dL at 1 year after transplantation (P < .01). The pre-transplant low ERI group (<10) showed significantly higher hemoglobin levels compared with the pre-transplant high ERI group (≥ 10; 12.9 ± 1.14 mg/dL versus 11.8 ± 1.76 mg/dL, respectively; P = .03).
  
  
  CONCLUSIONS
  ESA hypo-responsiveness before KT carried over after KT. Low pre-transplant ERI might be a sentinel marker for PTA.
authors: Division of Nephrology and Kidney Center, Kobe University Graduate School of Medicine, Kobe, Japan.
authors: K
authors: K
authors: Kitamura
authors: Division of Nephrology and Kidney Center, Kobe University Graduate School of Medicine, Kobe, Japan.
authors: K
authors: K
authors: Nakai
authors: Division of Nephrology and Kidney Center, Kobe University Graduate School of Medicine, Kobe, Japan.
authors: H
authors: H
authors: Fujii
authors: Division of Urology, Department of Surgery Related, Kobe University of Medicine, Kobe, Japan.
authors: T
authors: T
authors: Ishimura
authors: Division of Urology, Department of Surgery Related, Kobe University of Medicine, Kobe, Japan.
authors: M
authors: M
authors: Fujisawa
authors: Division of Nephrology and Kidney Center, Kobe University Graduate School of Medicine, Kobe, Japan. Electronic address: snishi@med.kobe-u.ac.jp.
authors: S
authors: S
authors: Nishi
mesh_terms: D000328:Adult; D000740:Anemia / Q000097:blood / Q000209:etiology*; D015415:Biomarkers / Q000097:blood; D004305:Dose-Response Relationship, Drug; D004920:Erythropoiesis / Q000502:physiology*; D004921:Erythropoietin / Q000008:administration & dosage*; D005260:Female; D006454:Hemoglobins / Q000378:metabolism*; D006801:Humans; D016030:Kidney Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D014184:Transplantation, Homologous / Q000009:adverse effects; D055815:Young Adult
chemical_list: D015415:Biomarkers; D006454:Hemoglobins; D004921:Erythropoietin