Skip to main content

Advertisement

SpringerLink
Log in

Anemia in pediatric renal transplant recipients

  • Original Article
  • Published:
Pediatric Nephrology Aims and scope Submit manuscript

Abstract

The aim of this study was to establish the prevalence of anemia in stable pediatric renal transplant recipients and to examine the association of anemia with renal function, immunosuppressants, angiotensin converting enzyme inhibitors, and growth, as well as iron, vitamin B12, and folate stores. This is a cross-sectional study of the 50 renal transplant recipients currently followed at our center. Patient data were collected regarding hematological parameters, growth, medications, renal function, underlying renal disease, delayed graft function, episodes of rejection, and iron or erythropoietin therapy post transplantation. The mean hemoglobin level (Hb) was 110 g/l and the overall prevalence of anemia was 60%, including 30% who were severely anemic (Hb<100 g/l). There was a high rate of iron deficiency (34%) and serum iron was the parameter of iron metabolism most closely associated with anemia. Hb in patients with low serum iron was 90.7 g/l versus 114.4 g/l in those with normal serum iron (P<0.01). Both univariate and multiple linear regression determined tacrolimus dose and creatinine clearance to be significant factors associated with anemia. Tacrolimus dose correlated with a 10 g/l reduction in Hb for every increase of tacrolimus dose of 0.054 mg/kg per day (P=0.001). The dose of mycophenolate was positively correlated with Hb, but this was likely to be confounded by our practice of dose reduction in the setting of anemia. Angiotensin converting enzyme inhibitor use was not associated with anemia. Severely anemic patients tended to be shorter, with a mean Z-score for height of –1.8 compared with –0.9 for those with normal Hb (P=0.02). Anemia is a significant and common problem in pediatric renal transplant patients. Deteriorating renal function is an important cause, but other factors like iron deficiency and immunosuppression are involved. Definition of iron deficiency is difficult and serum iron may be a valuable indicator. Medication doses, nutritional status, need for erythropoietin and iron, as well as poor graft function and growth require systematic scrutiny in the care of the anemic renal transplant recipient.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Miles A, Markell M, Daskalakis P, Sumrani N, Hong J, Sommer B, Friedman E (1997) Anaemia following renal transplantation: erythropoietin response and iron deficiency. Clin Transplant 11:313–315

    CAS  PubMed  Google Scholar 

  2. Nampoory M, Johny K, Al-Hilali N, Seshadri M, Kanagasabhapathy A (1996) Erythropoietin deficiency and relative resistance cause anaemia in post-renal transplant recipients with normal renal function. Nephrol Dial Transplant 11:177–181

    CAS  PubMed  Google Scholar 

  3. Vanrenterghem Y, Ponticelli C, Morales JM, Abramowicz D, Baboolal K, Eklund B, Kliem V, Legendre C, Morais AL, Vincenti S, Vincenti F (2003) Prevalence and management of anemia in renal transplant recipients: a European survey. Am J Transplant 3:835–845

    PubMed  Google Scholar 

  4. Yorgin P, Belson A, Sanchez J, Al Uzri A, Sarwal M, Bloch D, Oehlert J, Salvatierra O, Alexander S (2002) Unexpectedly high prevalence of posttransplant anemia in pediatric and young adult renal transplant recipients. Am J Kidney Dis 40:1306–1318

    Article  CAS  PubMed  Google Scholar 

  5. Schwartz GJ, Haycock GB, Edelmann CM, Spitzer A (1976) A simple estimate of glomerular filtration rate in children derived from body length and plasma creatinine. Pediatrics 58:259–263

    CAS  PubMed  Google Scholar 

  6. Bain B (1989) Blood cells a practical guide. Gower Medical

  7. Dacie JV, Lewis SM (eds) (1995) Practical haematology, 8th edn. Churchill Livingstone, Edinburgh

  8. Hall R, Malia RG (eds) (1984) Medical laboratory haematology. Butterworth, London

  9. Nathan DG, Oski FA (eds) (1993) Haematology of infancy and childhood, 4th edn. Saunders, Philadelphia

  10. Oski FA, Naiman JL (eds) (1982) Hematologic problems in the newborn, 3rd edn. Saunders, Philadelphia

  11. Williams (ed) (1996) Hematology, 5th edn.

  12. Wintrobe MM (ed) (1993) Clinical hematology, 9th edn. Lea and Febiger, London

  13. Burtis CA, Ashwood ER (1994) Tietz textbook of clinical chemistry, 2nd edn. Saunders, Philadelphia

  14. Cole T, Freeman J, Preece M (1998) British 1990 growth reference centiles for weight, height, body mass index and head circumference fitted by maximum penalized likelihood. Stat Med 17:407–429

    CAS  PubMed  Google Scholar 

  15. Stata (2003) Stat Statistical Software: Release 8.0. College Station, Texas

    Google Scholar 

  16. Peter C, Latta K, Graf D, Offner G, Brodehl J (1998) Does tacrolimus cause more severe anaemia than cyclosporin A in children after renal transplantation? Transpl Int 11 [Suppl 1]:S328–S330

  17. Saito S, Fujiwara T, Sakagami K, Matsuno T, Tanaka N (1998) Anaemia following renal transplantation. Transplant Proc 30:3025–3026

    Article  CAS  PubMed  Google Scholar 

  18. Arbeiter K, Greenbaum L, Balzar E, Muller T, Hofmeister F, Bidmon B, Aufricht C (1998) Reproducible erythroid aplasia caused by mycophenolate mofetil. Pediatr Nephrol 14:195–197

    Article  Google Scholar 

  19. Gossman J, Thurmann P, Bachmann T, Weller S, Kachel H, Schoeppe W, Scheuermannn E (1996) Mechanism of angiotensin converting enzyme inhibitor-related anemia in renal transplant recipients. Kidney Int 50:973–978

    PubMed  Google Scholar 

  20. Gaston RS, Julian BA, Diethelm, Curtis JJ (1991) Effect of enalapril on erythrocytosis after renal transplantation. Ann Intern Med 115:954–955

    CAS  PubMed  Google Scholar 

  21. Stigant C, Cohen J, Vovera M, Zaltman J (2000) ACE inhibitors and angiotensin II antagonists in renal transplantation: an analysis of safety and efficacy. Am J Kidney Dis 35:58–63

    Google Scholar 

  22. Muirhead N (1999) Erythropoietin and transplantation. Kidney Int 55 [Suppl 69]:S86–S92

  23. Schaeffer R, Schaeffer L (1999) Evaluation of iron status in renal failure patients. Kidney Int 55 [Suppl 69]:S44–S48

    Google Scholar 

  24. Lorenz M, Kletzmayr J, Perschl A, Furrer A, Horl W, Sunder-Plassman G (2002) Anemia and iron deficiencies among long-term renal transplant recipients. J Am Soc Nephrol 13:794–797

    PubMed  Google Scholar 

  25. CARI guidelines (2000) Caring for Australians with renal impairment: biochemical and haematological targets. Guideline 7, pp 19–26

    Google Scholar 

  26. Al-Uzri A, Yorgin P, Kling P (2003) Anaemia in children after transplantation: etiology and the effect of immunosuppressive therapy on erythropoiesis. Pediatr Transplant 7:253–264

    Article  CAS  PubMed  Google Scholar 

  27. Hokken-Koelega A, Stijnen T, Ridder M de, Muinck Keizer-Schrama F de, Wolff E, Jong M de, Donckerwolcke R, Groothoff J, Blum W, Drop S (1994) Growth hormone treatment in growth-retarded adolescents after renal transplant. Lancet 343:1313–1317

    CAS  PubMed  Google Scholar 

  28. Hokken-Koelega A, Zaal E van, Bergen W van, Stijnen T, Ridder M de, Wolff E de, Jong C de, Donckerwolcke R, Muinck Keizer-Schrama F de, Drop S (1994) Final height and its predictive factors after renal transplantation in childhood. Pediatr Res 36:323–328

    CAS  PubMed  Google Scholar 

  29. Guest G, Bérard E, Crosnier H, Chevallier T, Rappaport R, Broyer M (1998) Effects of growth hormone in short children after renal transplantation. Pediatr Nephrol 12:437–446

    Article  CAS  PubMed  Google Scholar 

  30. Ninik A, McTaggart S, Gulati S, Powell H, Jones C, Walker R (2002) Factors influencing growth and final height after renal transplantation. Pediatr Transplant 6:219–223

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Nephrology, Royal Children’s Hospital, Flemington Road, 3052, Parkville, Victoria, Australia

    Joshua Yehuda Kausman, Harley Robert Powell & Colin Lindsay Jones

Authors
  1. Joshua Yehuda Kausman
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Harley Robert Powell
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Colin Lindsay Jones
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Joshua Yehuda Kausman.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Kausman, J.Y., Powell, H.R. & Jones, C.L. Anemia in pediatric renal transplant recipients. Pediatr Nephrol 19, 526–530 (2004). https://doi.org/10.1007/s00467-004-1427-y

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00467-004-1427-y

Keywords

Search

Navigation