Anemia is a predictor of graft loss but not cardiovascular events and all-cause mortality in renal transplant recipients: follow-up data from the ALERT study

Clin Transplant. 2013 Nov-Dec;27(6):E636-43. doi: 10.1111/ctr.12220. Epub 2013 Sep 2.

Abstract

Background: It is well established that post-transplantation anemia (PTA) in renal transplant recipients (RTRs) is associated with reduced graft survival. However, there is an uncertainty of the effect of PTA on cardiovascular events and all-cause mortality. We examined prospectively in a large cohort of erythropoietin-naive patients the effects of PTA on cardiovascular morbidity, patient survival, and graft survival.

Methods: A prospective cohort study of RTRs (n = 2102) included in the ALERT study. Cox regression models were used to evaluate the impact of PTA on study endpoints: first occurrence of a major adverse cardiac event, all-cause death, and the incidence of death-censored graft loss. Mean follow-up was 6.7 yr. All endpoints were adjudicated by an independent endpoint committee.

Results: Twenty-nine percent of women and 30% of men were anemic. Hemoglobin levels were not associated with any effect on cardiovascular morbidity and mortality (HR 0.97 [0.90-1.05] per g/dL, p = 0.48) or all-cause death (HR 0.96 [0.90-1.03] per g/dL, p = 0.24) after extensive multivariate adjustments for clinical and demographic factors. Hemoglobin levels were negatively associated with graft loss (HR 0.86 [0.80-0.92] per g/dL, p < 0.001).

Conclusions: PTA was not associated with an increased incidence of cardiovascular morbidity and mortality or all-cause mortality.

Keywords: anemia; chronic kidney disease; graft survival; kidney transplantation; mortality.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Adult
  • Anemia / diagnosis*
  • Anemia / mortality
  • Cardiovascular Diseases / mortality*
  • Cause of Death
  • Double-Blind Method
  • Female
  • Follow-Up Studies
  • Glomerular Filtration Rate
  • Humans
  • Kidney Failure, Chronic / diagnosis*
  • Kidney Failure, Chronic / mortality
  • Kidney Function Tests
  • Kidney Transplantation*
  • Male
  • Middle Aged
  • Postoperative Complications
  • Prognosis
  • Prospective Studies
  • Risk Factors
  • Survival Rate