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NDT Advance Access originally published online on November 28, 2007
Nephrology Dialysis Transplantation 2008 23(5):1728-1734; doi:10.1093/ndt/gfm815
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© The Author [2007]. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org


Anaemia and congestive heart failure early post-renal transplantation

Richard Borrows, Marina Loucaidou, Gary Chusney, Sarah Borrows, Jen Van Tromp, Tom Cairns, Megan Griffith, Nadey Hakim, Adam McLean, Andrew Palmer, Vassilios Papalois and David Taube

West London Renal and Transplant Centre, Hammersmith Hospital, Du Cane Road, London W12 0HS, United Kingdom

Correspondence and offprint requests to: R. Borrows, Department of Nephrology, University Hospital Birmingham, Edgbaston, Birmingham B15, United Kingdom. Tel: +44-121-627-5715; Fax: +44-121-627-2527; E-mail: richard.borrows{at}uhb.nhs.uk



  Abstract

Background. Anaemia is common following renal transplantation and is associated with the development of congestive heart failure (CHF). However the prevalence of anaemia in the first year following transplantation and the association between anaemia occurring early and the development of CHF have been understudied.

Methods. In this study, 132 incident patients undergoing tacrolimus and mycophenolate mofetil-based renal transplantation were studied for the prevalence of, and risk factors for, anaemia and CHF in the early period post transplantation.

Results. Anaemia occurred in 94.5% and 53.1% of patients at 1 week and 12 months, respectively, and was associated with allograft dysfunction, hypoalbuminaemia, higher mycophenolic acid (MPA) levels, bacterial infection and hypoalbuminaemia. The association with hypoalbuminaemia may reflect the presence of chronic inflammation post-transplantation. Of patients displaying haemoglobin <11 g/dl, 41.1% and 29.4% were treated with erythropoiesis stimulating agents (ESAs) at 1 and 12 months respectively. CHF developed in 26 patients beyond 1 month post-transplantation, with echocardiographic left ventricular systolic function preserved in all but one. CHF was associated with anaemia and lower haemoglobin, allograft dysfunction, duration of dialysis and left ventricular hypertrophy on echocardiography prior to transplantation, suggesting the aetiology of CHF may involve the interplay of diastolic cardiac dysfunction, pre-load mismatch and after-load mismatch.

Conclusions. Modification of risk factors may improve anaemia management post transplantation. Reducing the prevalence of anaemia may in turn reduce the incidence of CHF—these observations support the need for clinical trials to determine how anaemia management may impact CHF incidence.

Keywords: anaemia; congestive heart failure; kidney transplant

Received for publication: 2. 6.07
Accepted in revised form: 18.10.07


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