Ott U, Busch M, Steiner T, Wolf G
Department of Internal Medicine III, Friedrich-Schiller-University, Jena, Germany.
Transplant Proc. 2008 Dec;40(10):3481-4. doi: 10.1016/j.transproceed.2008.07.139.
In end-stage renal disease patients anemia is known to be an independent risk factor for cardiovascular disease and death. In a monocenter retrospective analysis, we investigated 207 stable patients (68 women/139 men) who underwent a first renal transplantation. Immunosuppressive therapy was performed with either cyclosporine plus mycophenolate mofetil, tacrolimus plus mycophenolate mofetil, or rapamycin plus mycophenolate mofetil; 43.5% of the patients were treated with steroids. Seventy-eight patients (37.7%) displayed anemia, including 8.7% with a severe disorder displaying an average hemoglobin (Hb) level of <6.8 mmo/L in men and <6.2 mmol/L in women. In 8.2% of the cases, we observed moderate anemia (Hb 6.8-7.4 mmol/L in men and 6.2-6.8 mmol/L in women), and in 20.8% (29 men and 14 women), mild anemia (Hb <8.06 mmol/L in men and <7.45 mmol/L in women). Erythropoietin was administered in 55.5% of patients with severe anemia, 53% with moderate anemia, and 11.6% with mild anemia. Serum creatinine level was a significant predictor of anemia (B -0.004; SE 0.001; P < .01). Among patients with creatinine >200 micromol/L, 63% were anemic compared with 22% of those with a serum creatinine level <200 micromol/L (P < .05). No correlation was observed with immunosuppressive medication or treatment with angiotensin-converting enzyme inhibitors/angiotensin-II receptor antagonists. During a 3-year follow-up, both mortality and graft failure rates were significantly greater among anemic patients nonanemic patients (mortality 3.3% vs 0.5%, P < .001; graft failure 4.3% vs 0%, P < .001). We found an unexpectedly high incidence of anemia in patients with well-functioning grafts. Anemia as a risk factor for mortality and graft failure should be treated more intensively among renal transplant patients.
已知在终末期肾病患者中，贫血是心血管疾病和死亡的独立危险因素。在一项单中心回顾性分析中，我们调查了207例首次接受肾移植的稳定患者（68例女性/139例男性）。免疫抑制治疗采用环孢素加霉酚酸酯、他克莫司加霉酚酸酯或雷帕霉素加霉酚酸酯；43.5%的患者接受了类固醇治疗。78例患者（37.7%）出现贫血，其中8.7%为严重贫血，男性平均血红蛋白（Hb）水平<6.8 mmol/L，女性<6.2 mmol/L。在8.2%的病例中，我们观察到中度贫血（男性Hb 6.8 - 7.4 mmol/L，女性6.2 - 6.8 mmol/L），在20.8%（29例男性和14例女性）中为轻度贫血（男性Hb<8.06 mmol/L，女性<7.45 mmol/L）。55.5%的重度贫血患者、53%的中度贫血患者和11.6%的轻度贫血患者接受了促红细胞生成素治疗。血清肌酐水平是贫血的显著预测指标（B -0.004；SE 0.001；P<.01）。肌酐>200微摩尔/升的患者中，63%贫血，而血清肌酐水平<200微摩尔/升的患者中这一比例为22%（P<.05）。未观察到与免疫抑制药物或血管紧张素转换酶抑制剂/血管紧张素II受体拮抗剂治疗的相关性。在3年的随访中，贫血患者的死亡率和移植失败率均显著高于非贫血患者（死亡率3.3%对0.5%，P<.001；移植失败率4.3%对0%，P<.001）。我们发现移植功能良好的患者中贫血发生率出乎意料地高。在肾移植患者中，应更积极地治疗作为死亡和移植失败危险因素的贫血。
