title: Anemia in children following renal transplantation-results from the ESPN/ERA-EDTA Registry.
abstract: BACKGROUND
  Our aim was to determine the prevalence of sub-target hemoglobin (Hb) levels in children with a renal allograft and to identify potential determinants associated with these Hb levels.
  
  
  METHODS
  Data from 3669 children with a functioning renal allograft, aged <18 years between 1 January 2000 and 31 December 2012, from 20 European countries were retrieved from the ESPN/ERA-EDTA Registry, providing 16,170 Hb measurements.
  
  
  RESULTS
  According to the NKF/KDOQI classification and the UK-NICE guidelines, 49.8 and 7.8% of the patients, respectively, were anemic. Hb levels were strongly associated with graft function, with Hb levels of 12.6 g/dl in children with chronic kidney disease (CKD) stage 1, declining to 10.7 g/dl in children with CKD stage 5 (P < 0.001). Higher Hb levels were associated with the use of tacrolimus compared to ciclosporin (0.14 g/dl; 95% confidence interval 0.02-0.27; P = 0.002). Low Hb levels were associated with an increased risk of graft failure (P = 0.01) or combined graft failure and death (P < 0.01), but not with death alone (not significant).
  
  
  CONCLUSIONS
  Anemia is present in a significant proportion of European pediatric kidney transplant recipients and is associated with renal allograft dysfunction and type of immunosuppressants used. In our patient cohort, higher Hb levels were associated with better graft and patient survival and less hypertension.
authors.affiliation: Department of Paediatric Nephrology, Sydney Children's Hospital, Sydney, Australia.
authors.forename: Leah A
authors.initials: LA
authors.lastname: Krischock
authors.affiliation: ESPN/ERA-EDTA Registry, Department of Medical Informatics, Academic Medical Center, PO Box 22700, Amsterdam, The Netherlands. k.j.vanstralen@amc.uva.lnl.
authors.forename: Karlijn J
authors.initials: KJ
authors.lastname: van Stralen
authors.affiliation: G Gaslini Hospital, Genova, Italy.
authors.forename: Enrico
authors.initials: E
authors.lastname: Verrina
authors.affiliation: Bristol Royal Hospital for Children, Bristol, UK.
authors.forename: E Jane
authors.initials: EJ
authors.lastname: Tizard
authors.affiliation: ESPN/ERA-EDTA Registry, Department of Medical Informatics, Academic Medical Center, PO Box 22700, Amsterdam, The Netherlands.
authors.forename: Marjolein
authors.initials: M
authors.lastname: Bonthuis
authors.affiliation: Semmelweis University Budapest, Budapest, Hungary.
authors.forename: György
authors.initials: G
authors.lastname: Reusz
authors.affiliation: Nottingham University Hospitals, Nottingham, UK.
authors.forename: Farida K
authors.initials: FK
authors.lastname: Hussain
authors.affiliation: Vilnius University, Vilnius, Lithuania.
authors.forename: Augustina
authors.initials: A
authors.lastname: Jankauskiene
authors.affiliation: Children's Hospital University Medical Center, Ljubljana, Slovenia.
authors.forename: Gregor
authors.initials: G
authors.lastname: Novljan
authors.affiliation: University Children Hospital, Belgrade, Serbia.
authors.forename: Brankica
authors.initials: B
authors.lastname: Spasojević-Dimitrijeva
authors.affiliation: Department of Pediatrics, Faculty of Medicine, Slovak Medical University (SMU), Bratislava, Slovak Republic.
authors.forename: Ludmila
authors.initials: L
authors.lastname: Podracka
authors.affiliation: Medical University of Vienna, Vienna, Austria.
authors.forename: Vera
authors.initials: V
authors.lastname: Zaller
authors.affiliation: ESPN/ERA-EDTA Registry, Department of Medical Informatics, Academic Medical Center, PO Box 22700, Amsterdam, The Netherlands.
authors.forename: Kitty J
authors.initials: KJ
authors.lastname: Jager
authors.affiliation: University of Heidelberg Center for Pediatrics and Adolescent Medicine, Heidelberg, Germany.
authors.forename: Franz
authors.initials: F
authors.lastname: Schaefer
mesh_terms: D000293:Adolescent; D000740:Anemia / Q000453:epidemiology / Q000209:etiology*; D002648:Child; D002675:Child, Preschool; D005060:Europe; D005260:Female; D006454:Hemoglobins / Q000032:analysis; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects*; D007676:Kidney Failure, Chronic / Q000150:complications / Q000601:surgery*; D016030:Kidney Transplantation / Q000009:adverse effects*; D008297:Male; D015995:Prevalence; D012042:Registries; D012307:Risk Factors
chemical_list: D006454:Hemoglobins; D007166:Immunosuppressive Agents
keywords: Anemia; Graft survival; Hb level; Immunosuppressive therapy; Pediatrics; Transplantation