Abstract
// Huang Gang 1 , Li Jun 1 , Chen Guodong 1 , Chen Lizhong 1 and Qiu Jiang 1 1 Division of Organ Transplantation, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510080, China Correspondence to: Qiu Jiang, email: qiujiangdoc@163.com Keywords: anemia, kidney transplantation, creatinine, graft loss rate, all-cause death rate Received: April 23, 2017 Accepted: August 17, 2017 Published: December 06, 2017 ABSTRACT Background: The impact of anemia on graft loss rate and all-cause death rate remains controversial in renal transplant recipients. We performed a meta-analysis to explore the influence of anemia correction on the outcomes in renal transplant recipients. Materials and Methods: We searched PubMed and EMBASE databases from January 1st 1981 to December 31st, 2016 to identify potential studies assessing the impact of anemia on kidney transplantation. Fixed or random effect model was used according to the heterogeneity. Potential heterogeneity was checked by sensitivity analysis and meta-regression analysis. Results: A total of 9 randomized controlled trials with 1387 participants (mean age ranged from 39 to 53years) were included. Our results showed that anemia correction significantly decreased the creatinine level (WMD 0.52 mg/dl; 95% CI: 0.12, 0.92; P = 0.011), graft loss rate (0.07, 95% CI:0.05, 0.08; P < 0.0001) and all-cause death rate (0.01, 95% CI:0.00,0.01; P = 0.023). Furthermore, comparing with control group, erythropoietin (EPO) treatment greatly decreased creatinine level in renal transplant recipients (WMD 1.15 mg/dl; 95% CI: 0.27, 2.03 vs. WMD 0.05 mg/dl; 95% CI: −0.13, 0.23; P < 0.0001). Conclusions: Our findings showed that anemia correction reduced creatinine level, graft loss rate and all-cause death rate in renal transplant recipients. And EPO treatment is a good choice for anemia correction in renal transplant recipients.
Highlights
Anemia is a common complication of chronic kidney disease (CKD)
Our results showed that anemia correction significantly decreased the creatinine level (WMD 0.52 mg/dl; 95% confidence interval (CI): 0.12, 0.92; P = 0.011), graft loss rate (0.07, 95% CI:0.05, 0.08; P < 0.0001) and allcause death rate (0.01, 95% CI:0.00,0.01; P = 0.023)
Comparing with control group, erythropoietin (EPO) treatment greatly decreased creatinine level in renal transplant recipients (WMD 1.15 mg/dl; 95% CI: 0.27, 2.03 vs. weighted mean difference (WMD) 0.05 mg/ dl; 95% CI: −0.13, 0.23; P < 0.0001)
Summary
Anemia is a common complication of chronic kidney disease (CKD). And even after kidney transplantation, there is still a high prevalence (20% to 60%) of anemia [1]. It has been demonstrated that anemia is associated with cardiovascular death in patients with CKD [2] and poor long-term survival after kidney transplantation [3]. The impact of anemia on graft loss rate and all-cause death rate remains controversial in kidney transplantation [4, 5]. A series of cause have been demonstrated to be related with anemia in patients with kidney transplantation including chronic prescription of immunosuppressive drugs, antihypertensive drug angiotensin-converting enzyme inhibitors and angiotensin-receptor blockers, impaired kidney allograft function and etc [6, 7]. Previous studies demonstrated that anemia correction with EPO treatment reduced the postoperative requirement for blood transfusions and had no deleterious effects on kidney graft function in renal transplant recipients [8]. The impact of anemia on graft loss rate and all-cause death rate remains controversial in renal transplant recipients. We performed a meta-analysis to explore the influence of anemia correction on the outcomes in renal transplant recipients
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