Neutrophil Gelatinase-Associated Lipocalin Is a New and Sensitive Marker of Kidney Function in Chronic Kidney Disease Patients and Renal Allograft Recipients

Background/aims

Few biomarkers exist to monitor chronic kidney disease (CKD). Neutrophil gelatinase-associated lipocalin (NGAL), a member of lipocalin family, has recently been proven useful to quantitate CKD. The aim of the study was to assess whether NGAL could represent a novel, sensitive marker of kidney function in adult patients with CKD and in kidney transplant recipients.

Methods

We studied possible relations between serum NGAL, creatinine, and estimated glomerular filtration rate (eGFR) in 80 nondiabetic patients with CKD stages 2 to 4; 80 nondiabetic kidney transplant recipients on a calcineurin inhibitor mycophenolate mofetil, or azathioprine as well as prednisone and in healthy volunteers (n = 32, mean age 50 years).

Results

Serum NGAL and creatinine values were significantly higher and eGFR significantly lower in kidney allograft recipients and patients with CKD compared with controls. NGAL rose gradually, reaching the higher value in stage 4 CKD. In univariate analysis serum NGAL was related to serum creatinine, hemoglobin, hematocrit, leukocyte count, and eGFR. Predictors of serum NGAL were creatinine and eGFR among patients with CKD. On univariate analysis serum NGAL was related to serum creatinine, urea, hemoglobin, hematocrit, white blood cell count, calcineurin concentration, eGFR, and albumin in kidney transplant recipients. On multiple regression analysis, predictors of NGAL were creatinine, calcineurin concentration, and high-sensitivity C-reactive protein. In healthy volunteers, serum NGAL correlated with age, serum creatinine, eGFR, and leukocyte count.

Conclusion

NGAL should be investigated as a potential early, sensitive marker of kidney impairment/injury, which might provide an additional accurate measure of kidney impairment in CKD and among transplant recipients, particularly at advanced stages.     

Renalase, a novel regulator of blood pressure, is predicted by kidney function in renal transplant recipients

Background

Renalase is an enzyme that catabolizes catecholamines such as adrenaline and noradrenaline in the circulation. The human kidney releases this protein into the bloodstream to regulate blood pressure. In kidney transplant recipients, the prevalence of hypertension is 60%-80%.

Objective

The aim of our study was to assess possible correlations between renalase, blood pressure, and kidney function among 89 prevalent kidney allograft recipients. To obtain normal ranges, we also studied renalase levels in 27 healthy volunteers.

Methods

Complete blood counts, urea, serum lipids, fasting glucose, and creatinine were measured by standard laboratory methods in the hospital central laboratory. Renalase was assessed with the use of a commercially available kit.

Results

In kidney transplant recipients renalase was significantly higher than in healthy volunteers (P < .001). In kidney transplant recipients, renalase correlated with age (r = 0.29; P < .05), time after transplantation (r = 0.34; P < .01), systolic blood pressure (r = 0.28; P < .05), diastolic blood pressure (r = 0.27; P < .05), serum creatinine (r = 0.49; P < .001), estimated glomerular filtration rate (Chronic Kidney Disease Endemiology collaboration: r = −0.44; P < .0001; Modification of Diet in Renal Disease: r = −0.43; P < .001; Cockcroft-Gault r = −0.39; P < .01), serum phosphate (r = 0.34; P < .05). Upon multiple regression analysis renalase was predicted by 70% using age (beta value 0.21, P = 0.043), time after transplantation (beta value, 0.22; P = .037), serum creatinine (beta value, 0.50; P = .016), and diastolic blood pressure (beta value, 0.33; P = .027).

Conclusions

Renalase is highly elevated in kidney transplant recipients, predominantly dependent on kidney function, which deteriorates with time after kidney transplantation and age. Further studies are needed to establish its putative role in the pathogenesis of hypertension after transplantation and possible novel targeted therapies.     

Early postoperative spectral Doppler parameters of renal transplants: the effect of donor and recipient factors

Background

The objective of this study was to explore the donor and recipient factors related to the spectral Doppler parameters of the transplant kidney in the early posttransplantation period.

Methods

This retrospective study included 76 patients who underwent renal transplantation assessed using Doppler ultrasonography (US) on the first postoperative day. We compared spectral Doppler parameters (peak systolic velocity [PSV] and resistive index [RI]) of the segmental artery of the transplant kidney according to the type of renal transplant, level of serum creatinine (SCr) of donor prior to organ donation, and donor/recipient age.

Results

RI was significantly higher in deceased-donor kidney transplantation (DDKT) as compared with living-donor kidney transplantation (LDKT; 0.73 ± 0.10 vs 0.66 ± 0.11; P = .007). In the DDKT recipients, multivariate analysis showed donor SCr was the only factor affecting PSV (P = .023), whereas recipient age was the only factor affecting RI (P = .035). In the LDKT recipients, multivariate analysis showed recipient age was the only factor affecting both PSV (P = .009) and RI (P = .018).

Conclusion

Spectral Doppler parameters in the early posttransplantation period are related to the type of renal transplant, donor renal function, and recipient age. These factors should be taken into consideration when interpreting the results of spectral Doppler US.     

Hyperuricemia after renal transplantation

Background

Hyperuricemia is a common complication after kidney transplantation, and may adversely affect graft survival.

Objective

To assess the prevalence of and predictors for development of hyperuricemia after renal transplantation.

Materials and Methods

Hyperuricemia was defined as a serum uric acid concentration of at least 7.0 mg/dL in men and 6.0 mg/dL in women. From March 2008 to May 2010, uric acid concentration was measured in 12,767 blood samples from 2961 adult renal transplant recipients (64% male and 36% female patients).

Results

Hyperuricemia was observed in 1553 patients (52.4%). The disorder frequently occurred in women (P = .003) and in patients with impaired renal graft function (P = .00). After adjustment for sex, serum creatinine concentration, diabetes mellitus, cyclosporine concentration, and dyslipidemia, only female sex (P = .03) and renal allograft dysfunction (P = .05) were associated with hyperuricemia after kidney transplantation.

Conclusion

Hyperuricemia is a common complication after kidney transplantation, and renal allograft insufficiency predisposes to higher uric acid concentration.     

Graft infection in kidney recipients and its relation to transplanted kidney function

Introduction

Following kidney transplantation, septic complications are the leading causes of therapeutic failure including recipient death or graft removal. The serum creatinine level is one of the earliest metrics of kidney metabolic function. We examined the influence of graft infection on serum creatinine levels in kidney recipients.

Study design

We analyzed the function of 220 kidneys transplanted in nine centers in Poland. The kidneys were recovered from 146 multiorgan donors. Donor urea and creatinine levels were within the normal range. We investigated the influence of perioperative graft infection incidence on recipient creatinine levels at 1, 2, 3, 7, 14, 30, 90, and 180 days after kidney transplantation. The association of the serum creatinine level with categorical variables was assessed using either Student t test analysis of variance and multivariate techniques. In all analyses P < .05 indicated statistical significance.

Results

There were 25 graft infections revealing a significant relationship with increased recipient serum creatinine level after kidney transplantation (P = .003). Multivariate analysis confirmed the impact of infection.

Conclusion

Perioperative kidney graft infection influenced graft funtion in the early and late periods post-transplantation.     

Urinomas protect renal function in posterior urethral valves—a population based study

Background/Purpose

Urinomas have been thought to protect renal function in boys with posterior urethral valves (PUVs), although recent reports have disputed this. This study tested the hypothesis that urinomas protect global renal function in boys with PUV.

Methods

A retrospective analysis of all boys with PUV presenting to a tertiary unit derived from a region with an estimated population of 5.5 million was performed. Comparisons of the initial nadir creatinine, current creatinine, and renal status score (RSS) were made between those with and without urinomas. The RSS was derived from nephrology assessment of current renal status (0 = normal to 4 = end-stage renal failure or transplantation). Results were given as median (range), except for RSS, which was given as mean ± SEM. P ≤ .05 was regarded as significant.

Results

During 1989-2009, 9 of 89 PUV boys were diagnosed with urinomas. Initial nadir creatinine was statistically lower in boys with urinomas (31 [18-44] vs 45 [20-574] μmol/L, P < .01). Length of follow-up was similar (5.1 [2.2-17.3] vs 5.9 [1.8-19.7] years, P = .59). Follow-up creatinine was significantly lower in urinoma boys (44 [25-77] vs 61 [29-1227] μmol/L, P < .05), as was the RSS (0.14 ± 0.14 vs 0.91 ± 0.14, P < .01). No urinoma boys progressed to end-stage renal failure or required transplant.

Conclusion

This population-based study of PUV boys demonstrates that urinomas reduce nadir creatinine and significantly protect long-term global renal function.     

Comparison between thymoglobulin and ATGAM as an induction agent in adult kidney transplantation: a single-center experience

Objective

The best antithymocyte globulin (ATG) preparation for induction suppression in kidney transplant recipients is still not clear. The aim of this study was to identify short- and long-term outcomes in kidney transplant recipients who received Thymoglobulin or ATGAM as an induction agent.

Methods

We retrospectively reviewed patients who underwent kidney transplantation from 1996 to 2010. Recipients were classified according to the ATG preparation.

Results

One hundred fifty-two patients (64.4%) received thymoglobulin and 84 (35.6%) received ATGAM. The occurrence of delayed graft function in patients receiving Thymoglobulin was higher than in patients receiving ATGAM (P = .005), but serum creatinine levels and acute rejection after kidney transplantation were not different between the two groups. The death-censored graft survival curve in Thymoglobulin recipients was higher than in ATGAM recipients (P = .027). Bacterial infection was a predisposing factor for graft survival (P = .008).

Conclusion

The efficacy of Thymoglobulin induction is generally better than that of ATGAM induction, and prevention of bacterial infections was just as important as the use of ATG because bacterial infection was an important risk factor for graft failure.     

Survival Benefit in Heart Transplant Recipients Who Have Coronary Artery Disease Confirmed Using Angiography and Are Receiving Sirolimus

Introduction

The aim of this study was to assess efficacy and safety of sirolimus (SIR) in heart transplant recipients to prevent further development of coronary artery disease (TxCAD) already confirmed by using coronary angiography.

Material and Methods

We performed a retrospective case-control study involving all 60 heart transplant recipients receiving SIR in a number of combinations with other immunosuppressive drugs, and 60 matched individuals after heart transplantation treated without SIR. TxCAD was diagnosed using elective coronary angiography in 9 subjects in the study group (8 males and 1 female) of mean age 44 ± 11 years, including ischemic cardiomyopathy in 4 members. The control group of 15 individuals 15 males of mean age 47 ± 7 years, including ischemic cardiomyopathy in 8. We compared time to develop significant TxCAD and death caused by TxCAD, and all-cause deaths. Significance was assessed using log-rank and chi-square tests, when applicable.

Results

Significant TxCAD (critical coronary lesions, myocardial infarction or death) was observed in 5 (56%) patients receiving SIR and 11 (73%) without SIR (P = not significant [NS]). Time to develop significant TxCAD was comparable. There were 2 (22%) deaths in the SIR group and 8 (53%) in the control group (P = NS). Survival time was significantly longer among subjects receiving SIR (P = .02). None of deaths in the study group was caused by TxCAD compared with 6 (40%) deaths among controls (P = .09). Time of freedom from death caused by TxCAD was significantly longer in the study group (P = .023).

Conclusion

SIR prolonged survival in heart transplant recipients with TxCAD confirmed using coronary angiography.     

Association Between Serum Soluble CD30 and Serum Creatinine Before and After Renal Transplantation

Objective

There is increasing evidence that circulating levels of soluble CD30 (sCD30) may represent a biomarker for outcome in kidney transplantation. The aim of this study was to measure the pre- and posttransplantation serum levels of sCD30 in cadaveric kidney transplant recipients and correlate them with serum creatinine.

Patients and Methods

Serum sCD30 was measured by a commercial enzyme-linked immunosorbent assay (ELISA) from prospective samples of 38 kidney allograft recipients serially transplanted at our center. Samples were collected at day 0 pretransplantation and at months 6, 12, 18, and 24 posttransplantation. We also studied sera from 29 patients with chronic kidney disease (CKD) at different stages of the K/DOQI guidelines, as a control group.

Results

Serum levels of sCD30 decreased significantly in samples posttransplantation compared with pretransplantation. The significant decrease after transplantation may be related to the improvement in renal function since we observed a significant correlation between serum levels of sCD30 and creatinine (sCr) at all times of the study. In addition, the patients with chronic renal failure showed a significant association between serum sCD30 and sCr (r = .454; P = .013).

Conclusions

Our results did not suggest that the measurement of sCD30 may be used as a valuable biomarker in renal transplantation. Increased levels may be related to a decrease in its renal elimination.     

Impact of Recipient and Donor Nonimmunologic Factors on the Outcome of Deceased Donor Kidney Transplantation

Objective

To study the influence of nonimmunologic factors on the outcome of extended criteria deceased donor (DD) kidney transplants.

Method

This is a retrospective study of DD transplantation carried out from January 1, 2003 to December 31, 2007, to investigate the impact on graft survival and function of donor renal function at retrieval, cold ischemia time (CIT), delayed graft function (DGF), acute rejection episodes (ARE), age, and weight of donors and recipients, transplant center activities, cause of donor death, donor-recipient gender pairing and size of the donating intensive care unit (ICU).

Results

At retrieval, the frequency of donors with a creatinine clearance <60 mL/min, using the Cockcroft-Gault formula, and age >40 years were 31.7% and 32%, respectively. CIT > 24 hours, DGF, and ARE occurred in 27.1%, 33.4%, and 16.5% of cases, respectively. The overall 1- and 5-year graft and patient survival rates were 88% and 79.8% and 96.6% and 92.3%, respectively. The graft function was inferior with occurrences of ARE (P = .0001), DGF (P = .0001), CIT > 20 hours (P = .005), nontraumatic the donor death (P = .022), and donor ICUs bed capacity <20 (P = .03). The odds ratio (OR) for graft loss with DGF, ARE, and donors right kidneys were 7.74 (95% confidence interval [CI] 6-13.4; P = .0001), 4.47 (95% CI, 2.6-7.6; P = .0001) and 1.7 (95% CI, 1-2.8; P = .045), respectively. Graft function was not influenced by donor renal function at retrieval, donor weight, or donor- recipient gender pairings.

Conclusion

CIT and ARE had an impact on both graft survival and function. DGF and cerebrovascular accidents as the cause of donor death negatively affected graft function during follow-up. ICU center experience had a positive impact on graft survival. Patient survival was affected by recipient age >50 years and female to male donation versus other gender pairings. Neither donor age nor acute terminal rise in the donor serum creatinine affected graft function or survival, or patient mortality.     

Insulin Resistance and Insulin Secretion Changes in Kidney Transplant Recipients With Normal Graft Function Compared With Those With Delayed Graft Function Early After Transplantation

Introduction

We compared insulin resistance (IR) and insulin secretion (IS) among kidney transplant recipients with normal versus delayed graft function (DGF) early after transplantation.

Methods

We selected 55 kidney transplant recipients without a history of clinical diabetes mellitus. The basal values of glucose (G) and insulin (I) were used to calculate indices of IR and IS before, on the third day, as well as at the end of the first, second, and third weeks after transplantation.

Results

Before transplantation IR was more prevalent (62.5%) than impaired IS (20%; P = .012). Three weeks after engraftment, IR was significantly reduced (P < .001), whereas the reduction in the IS was not significant (P = .17). Splitting the results between normal and delayed functioning grafts showed a significant difference in both IR and IS between the 2 groups on the third day after transplantation (P = .018 and .024, respectively). Regression models showed that only cumulative administered cyclosporine dose and plasma creatinine were significantly (or near significantly) associated with IR (P = .04 and .07, respectively).

Conclusion

Among patients with DGF there was a significantly greater prevalence of IR and IS compared with successfully engrafted patients in the middle of the first week after transplantation. With resumption of normal kidney function among the DGF group, this difference disappeared at the end of the third week after transplantation.     

Early renal transplantation after donor renal angiography affects initial graft function

Background

Renal angiography of a living donor is a common radiologic examination before transplantation. However, the contrast agent used during this procedure can cause contrast nephropathy. There are insufficient data regarding whether this radiocontrast exposure detoriates renal function and survival after transplantation. In this study, we analyzed the effects of radiocontrast exposure to donors before transplant surgery on the incidence of delayed graft function (DGF) and on the outcomes of recipients at 1 year posttransplantation.

Methods

We divided 80 living donor transplantations according to the duration between the renal angiography and the transplantation procedure: Group 1 as early transplantation at ≤20 days (n = 42) versus group 2 of late transplantation at ≥20 days (n = 38). We retrospectively collected acute rejection episodes and graft survival at 1 year, monthly serum creatinine values of, DGF, proteinuria at 1 month, GFR at posttransplant day 3 month 1, and 1 year.

Results

There were 10 group 1 recipients (23.8%) and 2 group 2 (5.3%) subjects who experienced ≥1 acute rejection episode in the 1st posttransplant year (P = .02); 1 patient in each group experienced graft loss at 1 year (P = .941). DGF was observed in 9 (22%) versus 1 patient (2.6%) in group 2 (P = .009). Posttransplant day 3 creatinine values were significantly higher (P = .005) with significantly lower GFR values (P = .043) in group 1. However, creatinine and GFR levels were similar at 1 month and 1 year. Month 1 proteinuria levels were significantly higher in group 1 (P = .014). There was a significant negative correlation between renal angiography time and month 1 proteinuria (P = .014).

Conclusions

Early renal transplantation (within 2 weeks after renal angiography) in living kidney donors can detoriate initial graft function and cause DGF.     

Kidneys from deceased donors with oliguria are feasible for kidney transplantation

Background

Since kidneys from deceased donors with oliguria have not been widely used, compared their outcomes with those in recipients of kidneys without oliguria at the time of organ procurement.

Methods

We reviewed the deceased donors and kidney recipients between January 1999 and December 2009, all of whom were defined as standard criteria donors (SCD).

Results

The group included 26 recipients whose terminal serum creatinine level (P < .001), estimated glomerular filtration rates (P < .001), and deceased donor scores (P < .001) were higher than those of the control group. Delayed graft function (P = .044) occurred more often among recipients with donor kidneys with oliguria than those without oliguria, and their hospitalization period was longer (P = .012). The serum creatinine levels in both groups were comparable posttransplantation; there was no significant difference in graft survivals.

Conclusion

Deceased donors with oliguria at organ procurement appeared to be poor predictors of outcomes in the early posttransplantation period. Kidneys from deceased donors with oliguria should not be discarded for transplantation. The present study suggested that it is acceptable to use kidneys from selected deceased donors with oliguria.     

Evaluation of Cinacalcet HCl Treatment After Kidney Transplantation

Background

Hyperparathyroidism often remains or develops after kidney transplantation. Vitamin D sterol used as treatment for an elevated parathyroid hormone (PTH) level and associated bone disease may be contraindicated due to hypercalcemia. The calcimimetic cinacalcet HCl (cinacalcet), which lowers PTH and calcium (Ca) in chronic kidney disease patients, may represent an alternate therapeutic modality.

Methods

This multicenter, retrospective, observational study examined 41 kidney transplant patients receiving cinacalcet for ≥3 months starting ≥3 months posttransplantation. Levels of intact PTH, Ca, and phosphorus (P) were examined during the assessment phase (3-6 months after initiation).

Results

Median PTH decreased 21.8% during the assessment phase (P < .001), with 32.5% of patients exhibiting a ≥30% decrease in PTH from baseline. Median Ca decreased 6.8% (P < .0001). Median serum P rose 10.0% (P = .0124), but remained within normal limits. The estimated glomerular filtration rate was stable throughout the study.

Conclusions

Cinacalcet may be useful for the treatment of hyperparathyroidism after kidney transplantation. Randomized, prospectively designed clinical trials are required to confirm these results.     

Systemic vascular hemodynamics and transplanted kidney survival

Introduction

High blood pressure and arterial stiffness contribute independently to cardiovascular mortality in uremic patients. High blood pressure is an established risk factor for chronic allograft nephropathy, recently named interstitial fibrosis/tubular atrophy (IF/TA). We sought to assess whether heart afterload determinants: arterial stiffness and vascular resistance or impedance accelerate kidney graft failure upon long-term observation.

Methods

Using a noninvasive method of blood pressure waveform analysis, (HDI/PulseWave/CR-2000), we studied 160 consecutive kidney transplant recipients, who were at least 3 months after transplantation, for systolic (SBP), diastolic, and mean blood pressure; pulse rate; systemic vascular resistance and impedance as well as large and small artery compliance. The associations of the hemodynamic parameters with relative increases in serum creatinine for every year of graft survival (ΔCreat) were assessed using multiple linear regression analysis. Relationships between systemic hemodynamics and kidney graft loss due to IF/TA were evaluated by Cox regression analysis, including serum creatinine, time after transplantation, delayed graft function, human leukocyte antigen mismatch, panel-reactive antibodies, cold ischemia time, donor age glomerular filtration rate as well as prescribed cardiovascular and immunosuppressive drugs.

Results

Over 6.6 ± 0.4 years of follow-up, excluding four noncompliant patients, 11 patients died and 32 lost their kidney grafts, including 25 due to IF/TA. ΔCreat (10.3% ± 22.0%/y) was independently and positively associated with the initial SBP (β = 0.26; P = .001) and serum creatinine values (β = 0.16; P = .04). The risk of graft loss due to IF/TA was greater among patients with an increased serum creatinine (relative risk [RR] = 59.5 per nlog-unit increase; P < .001) or higher SBP (RR = 51.1 per nlog-unit increase; P = .04). Besides SBP, no other hemodynamic parameter was associated with graft failure.

Conclusions

The rate of kidney graft function deterioration and risk of transplant loss due to IF/TA are not independently influenced by systemic arterial compliance, resistance, or impedance. SBP appears to be the key circulatory parameter independently affecting the progression of IF/TA, and should be a therapeutic target.     

Posttransplant Diabetes Mellitus: Incidence and Risk Factors

Objective

Posttransplant diabetes mellitus (PTDM) is a common and serious complication of renal transplantation. Estimates of the incidence of PTDM after renal transplantation vary between 2% and 54%. The aim of the present study was to evaluate the incidence and risk factors for PTDM among our renal transplant patients.

Patients and Methods

In this study we evaluated 121 nondiabetic patients with end-stage renal disease (ESRD) who underwent kidney transplantation for the first time at our centers since 2005. All patients received the same protocol of immunosuppressive therapy. PTDM was defined according to the clinical practice recommendations of the American Diabetes Association.

Results

At 12 months following renal transplantation, 9.9% of patients developed PTDM. Patients with PTDM were significantly older (P = .013) and had higher body mass index (P = .001). There were significant differences (P ≤ .05) between PTDM and non-PTDM patients with respect to systolic blood pressure, serum triglycerides (TG), peritoneal dialysis as renal replacement therapy before transplantation, and duration of pretransplant dialysis therapy. Upon multivariate analysis, serum TG, systolic blood pressure, and body mass index were associated with PTDM (P ≤ .05).

Conclusions

The incidence at 12 months of PTDM among our renal transplant recipients was 9.9%. The most important factors associated with PTDM were serum TG, systolic blood pressure, and body mass index.     

Changes in magnesium and potassium homeostasis after conversion from a calcineurin inhibitor regimen to an mTOR inhibitor-based regimen

Background

Transplant recipients treated with calcineurin inhibitors (CNIs) frequently show hyperkalemia, metabolic acidosis, and hypomagnesemia which could be deleterious for some patients. Conversion to inhibitors of mammalian target of rapamycin (mTOR) could improve these electrolytic disturbances.

Objective

To evaluate the potassium and magnesium changes due to converting patients from CNIs to mTOR inhibitors.

Methods

Retrospective review of 138 renal transplant patients who were converted from CNIs to mTOR inhibitors over a 6-month observation period. The following parameters were determined: potassium, sodium, chloride, magnesium, urea, glucose, and creatinine in blood and urine. We also analyzed plasma bicarbonate and calculated plasma and urine anion gap and plasma osmolarity.

Results

One month after conversion, a decrease was observed in serum creatinine (1.75 ± 0.68 vs 1.61 ± 0.61 mg/dL; P = .01), plasma potassium (4.60 ± 0.52 vs 4.39 ± 0.53 mEq/L; P < .001), calculated plasma osmolarity (308.7 ± 8.5 vs 307.4 ± 8.4 mOsm/L; P < .036), fractional excretion of sodium (1.55 ± 0.69 vs 1.29 ± 0.65%; P < .003), and fractional excretion of magnesium (7.15 ± 4.08 vs 15.84 ± 3.64%; P < .001), with an increase in serum magnesium (1.77 ± 0.24 vs 1.95 ± 0.29 mg/dL; P < .001). At 3 and 6 months, these differences remained unchanged. The transtubular potassium gradient did not change.

Conclusions

We observed a decrease in serum magnesium due to renal magnesium wasting before switching from CNIs to mTOR inhibitors. After conversion, an increase in serum magnesium was observed together with a drop in the fractional excretion of this cation. A decrease in plasma potassium levels, plasma osmolarity, and fractional excretion of sodium consistent with minor aldosterone resistance was also detected after changing the immunosuppressive treatment.     

Anemia after kidney transplantation in adult recipients: prevalence and risk factors

Objective

To evaluate the prevalence of anemia and appraise its risk factors at 6 months after renal transplantation.

Materials and Methods

This retrospective study was performed between 2008 and 2010 in 2713 adult kidney transplant recipients to determine the prevalence of posttransplantation anemia. Anemia was defined as hemoglobin concentration of 12 g/dL or less in women and 13 g/dL or less in men.

Results

The prevalence of posttransplantation anemia was 52.7%, with severe anemia (hemoglobin ≤11 g/dL) detected in 24.4% of patients. Impaired renal function was the only risk factor associated with anemia (odds ratio, 3.6; P = .047). However, severe anemia after kidney transplantation was correlated with female sex (P = .001), renal allograft dysfunction (P = .00), and cytomegalovirus infection (P = .002).

Conclusion

The present study demonstrated a quite high prevalence of posttransplantation anemia, in particular associated with impaired renal allograft function. Severe anemia was correlated with female sex, degree of kidney graft dysfunction, and cytomegalovirus infection.