Anemia In Renal Transplant Recipients Research Articles

MO973: Optimization of Erythropoietin Stimulating Agents for Post-Transplant Anemia in Kidney Recipients: Prospective Randomized Controlled Trial

Abstract BACKGROUND AND AIMS Many studies suggested that chronic allograft nephropathy might progress faster in patients with PTA, but whether full correction of anemia improves renal outcomes is unknown. We aimed to assess the impact of full correction of chronic anemia in renal transplant recipients with stable graft function on patient and graft outcome along one year follow-up. METHOD We enrolled 247 kidney recipients with stable graft function to be assessed for anemia. Eligible patients were randomized to achieve target hemoglobin between 11:12 g/dL (group 1, n = 183) or 13:15 g/dl (in group 2, n = 64) using erythropoietin receptor stimulating agents (ESA). Monthly clinical and laboratory evaluation of kidney graft function was carried out. Quality of life was assessed at the start and 12 months. RESULTS More females were found in group 1 (68.9%) versus (50%) in group 2 (P = 0.007), and the original disease was chronic glomerulonephritis (37.5%) followed by diabetic nephropathy (DN) (15.7%) in group 2; but DN patients predominate in group 1(P = 0.005). The studied groups were comparable regarding pretransplant comorbidities. Most patients received thymoglobulin as induction and most of them were maintained on cyclosporine. We did not find any significant difference between the two groups concerning posttransplant diabetes, BK viremia or malignancies (P > 0.05); however, better graft function was observed in group 2 at 6 months (P < 0.05). We found that required ESA doses were significantly higher in patients of group 1 from the sixth month. Group 1 showed higher mean blood pressure (P = 0.003) while group 2 showed higher mean albumin (P < 0.05). Graft outcome was comparable in both groups (P = 0.125), but mortality cases were significantly higher in group 1 (16 cases, 8.7%) (P = 0.005). CONCLUSION Full correction of PTA in renal transplant recipients had no positive impact on graft outcome but it was associated with better patient survival possibly due improved cardiovascular risk.

Experience With the Use of a Novel Agent, Hypoxia-Inducible Factor Prolyl Hydroxylase Inhibitor, for Posttransplant Anemia in Renal Transplant Recipients: A Case Report

In this study, we report on an experience with the use of a novel agent "roxadustat," a hypoxia-inducible factor prolyl hydroxylase inhibitor (HIF-PHI), for posttransplant anemia (PTA) in renal transplant recipients. Five renal transplant recipients treated as outpatients receiving 150 or 250 µg of "epoetin beta pegol," an erythropoiesis-stimulating agent (ESA), once every 3 months were converted to roxadustat, an HIF-PHI. The dose was 100 mg 3 times a week taken orally on Monday, Wednesday, and Friday. Data check was conducted at 1 month and every 3 months after its introduction, and hemoglobin (Hb), ferritin, and transferrin saturation (TSAT) levels were compared. At 1 month after conversion to roxadustat, Hb levels increased in all cases, the use of roxadustat was suspended/decreased in 2 cases who had Hb overshoot at 1 month, and ferritin and TSAT levels decreased in the initial stage of roxadustat conversion. During a 9-month period, Hb levels tended to increase in cases receiving oral iron administration, graft function was hardly affected, and there were no complications such as thrombosis. In conclusion, conversion from ESA to roxadustat was effective in the treatment of PTA. However, our overshoot case suggested that it might be better to start at a low dose in patients with low body weight, those undergoing iron administration, and those receiving a low dose of ESA. Furthermore, the low levels of ferritin and TSAT we observed at an early stage after roxadustat conversion suggested that there was an increased efficiency in iron utilization.

An evaluation of PJP prophylaxis and anemia among renal transplant recipients.

Dapone and atovaquone are therapeutic options for PJP prophylaxis in renal transplant recipients. The objective of this study was to evaluate the incidence of anemia in renal transplant recipients receiving these agents. This is an IRB-approved, retrospective analysis of adult renal transplant recipients who received either dapsone or atovaquone. The primary endpoint was the change in hemoglobin within 90days of drug initiation. Other endpoints of interest included incidence and management of anemia at multiple time points post-transplant. Categorical variables were compared with Pearson's chi-squared or Fischer's exact test and continuous data were compared utilizing Wilcoxon rank-sum test. Statistical analyses were performed using Stata 14.2. A total of 478 patients were screened for inclusion; 50 patients were evaluated in both the dapsone and atovaquone groups. In the dapsone and atovaquone groups, the median age was 52 and 50.5years, 44% and 42% were Caucasian, and median time to treatment initiation was 27 and 39days post-transplant, respectively. All patients receiving dapsone had normal G6PD function. There was no difference in baseline hemoglobin between groups (9.7g/dL vs 9.8g/dL, P=.83). The median nadir hemoglobin values were 8.6g/dL and 9.6g/dL in the dapsone and atovaquone groups, respectively (P=.047). The median decrease in hemoglobin from baseline to nadir was 1.3g/dL in dapsone patients and 0.2g/dL in atovaquone patients (P=.001). Dapsone was discontinued in 46% of patients, whereas atovaquone was discontinued in 18% (P=.001). Among renal transplant recipients with normal G6PD activity, dapsone is associated with greater hemoglobin reductions and rates of drug discontinuation as compared to atovaquone.

Factors Associated with Post-Transplant Anemia among Renal Transplant Recipients with Functioning Grafts in Sana’a City, Yemen

Objective: To assess the factors associated with anemia in renal transplant recipients with functioning grafts in Sana’a city, Yemen.
 Methods: One hundred and thirteen adult renal transplant recipients with functioning grafts were enrolled in this study in the period from Janury to December 2014. Biodata and clinical data were collected using a pre-designeddata collection sheet. Hemoglobin (Hb) concentration was measured, and anemia was defined as Hb concentration less than13.0 g/dLin males and less than 12.0 g/dL in females. The factors associated with anemia were analyzed, and independent predictors of post-transplant anemia (PTA) among renal transplant recipients were identified using a multivariable logistic regression model.
 Results: PTA was detected in 23.0% of renal transplant recipients with functioning grafts. Bivariate analysis showed a significant association of PTA with age of 50 years or older (Odds ratio (OR) = 2.7; 95% CI: 1.10–6.72; P = 0.03), history of acute rejection (OR = 3.6; 95% CI: 1.17–11.28; P = 0.019) and delayed graft function (OR = 6.2; 95% CI:1.60–24.16; P = 0.004). Multivariable analysis using a logistic regression model identified history of acute rejection (adjusted OR = 3.9; 95% CI: 1.11–12.94; P = 0.034) and delayed graft function (adjusted OR = 4.6; 95% CI: 1.07–19.81; P = 0.04) as independent risk factors for PTA among recipients. However, no association was found between PTA and recipient’s gender, graft source, immunosuppressive protocols, erythropoietin treatment or use of antihypertensive drugs.
 Conclusions: The prevalence of PTA among Yemeni renal transplant recipients is high, with history of acute rejection and delayed graft function being the independent risk factors. Therefore, it is recommended that physicians involved in renal transplantation consider the investigation and follow-up of transplant recipients for PTA and adopt appropriate preventive and therapeutic measures.

Factors Associated with Post-Transplant Anemia among Renal Transplant Recipients with Functioning Grafts in Sana’a City, Yemen

Objective: To assess the factors associated with anemia in renal transplant recipients with functioning grafts in Sana’a city, Yemen.
 Methods: One hundred and thirteen adult renal transplant recipients with functioning grafts were enrolled in this study in the period from Janury to December 2014. Biodata and clinical data were collected using a pre-designeddata collection sheet. Hemoglobin (Hb) concentration was measured, and anemia was defined as Hb concentration less than13.0 g/dLin males and less than 12.0 g/dL in females. The factors associated with anemia were analyzed, and independent predictors of post-transplant anemia (PTA) among renal transplant recipients were identified using a multivariable logistic regression model.
 Results: PTA was detected in 23.0% of renal transplant recipients with functioning grafts. Bivariate analysis showed a significant association of PTA with age of 50 years or older (Odds ratio (OR) = 2.7; 95% CI: 1.10–6.72; P = 0.03), history of acute rejection (OR = 3.6; 95% CI: 1.17–11.28; P = 0.019) and delayed graft function (OR = 6.2; 95% CI:1.60–24.16; P = 0.004). Multivariable analysis using a logistic regression model identified history of acute rejection (adjusted OR = 3.9; 95% CI: 1.11–12.94; P = 0.034) and delayed graft function (adjusted OR = 4.6; 95% CI: 1.07–19.81; P = 0.04) as independent risk factors for PTA among recipients. However, no association was found between PTA and recipient’s gender, graft source, immunosuppressive protocols, erythropoietin treatment or use of antihypertensive drugs.
 Conclusions: The prevalence of PTA among Yemeni renal transplant recipients is high, with history of acute rejection and delayed graft function being the independent risk factors. Therefore, it is recommended that physicians involved in renal transplantation consider the investigation and follow-up of transplant recipients for PTA and adopt appropriate preventive and therapeutic measures.

A case report on parvovirus induced anemia in renal transplant recipient

A case report on parvovirus induced anemia in renal transplant recipient

Efficacy of Subcutaneous Epoetin-Zeta on Anemia in Renal Transplant Recipients: A Single-Center Experience

BackgroundPersistent or “de novo” anemia (plasma hemoglobin <11 g/dL) may complicate the graft outcome in a significant number of renal transplant recipients. We describe a single-center experience with epoetin-zeta (EPO-Z), the biosimilar form for epoetin-alfa. MethodsTwenty patients were included in the study, 10 in treatment with different erythropoiesis-stimulating agents (ESA) and shifted to EPO-Z (shift group) and 10 who started EPO-Z treatment for anemia (naive group). All the patients had stable renal function and normal values of main inflammation markers and were prospectively followed up for 12 months. Iron supplements were administered during the study, as needed. ResultsIn the shift group, mean plasma hemoglobin levels >11 g/dL were maintained for the entire 1-year follow-up period, with average EPO-Z doses 3.4% higher than the corresponding doses of previous ESA; in the naive group, the target value was reached between the first and third months and remained stable throughout the study. Mean corpuscular volume did not vary in either group. No change was observed in glomerular filtration rate, nor in proteinuria or in main laboratory data. No drug-related side effect was reported. ConclusionsEPO-Z may be considered a valid alternative to different ESAs in renal transplant recipients, with an interesting pharmaco-economic profile, considering its lower cost.

Microalbuminuria Is Associated With High Prevalence of Anemia in Renal Transplant Recipients

Background and AimPrevalence of anemia is higher in diabetic patients with microalbuminuria than those with normoalbuminuria despite the absence of significant renal impairment. The aim of this study was to investigate whether there was a relationship between microalbuminuria and anemia in renal transplant recipients (RTRs). Patients and MethodTwenty-eight RTRs with microalbuminuria and 21 control RTRs with normoalbuminuria were classified based on urinary albumin creatinine ratios (UACR) of 0.03–0.3 versus <0.03, respectively. Anemia was defined as a hemoglobin level <13 g/dL for men and <12 g/dL for women. ResultsAnemia was observed in 13 (46.4%) microalbuminuric and 4 (19%) normoalbuminuric patients (P = 0.044). Hemoglobin level was significantly lower in the microalbuminuric than the normoalbuminuric group (13.3 ± 1.3 g/dL vs 14.4 ± 1.9 g/dL, respectively; P = .018). Although creatinine clearance was significantly higher among the normoalbuminuric group (84 ± 30 mL/min vs 65 ± 22 mL/min, respectively; P = .017), mean creatinine clearance in microalbuminuric group was >60 mL/min, the threshold value for anemia due to erythropoietin (EPO) deficiency. In contrast, there was no significant difference between the 2 groups for age, gender, donor source, and transplant duration. ConclusionAnemia was frequent among RTRs displaying microalbuminuria, which may reflect EPO deficiency due to the tubulointerstitial injury of chronic allograft nephropathy. The EPO deficiency may begin before significant deterioration in excretory function of the kidney.

Parvovirus B19 Infection and Severe Anemia in Renal Transplant Recipients

Kidney transplant (KT) recipients can develop symptomatic Parvovirus (PV) B19 infections, frequently associated with persistent anemia. The aim of this study was to evaluate the prevalence and clinical significance of PV B19 infection in anemic and non-anemic KT patients. Overall, out of 64 patients monitored for the presence of PV B19 by real-time PCR, 2 (3.12%) had an active PV B19 infection, in absence of other viral coinfections. The 2 cases occurred in nonanemic kidney transplant patients group (2/50, 4%), while none of the anemic transplant patients (0/14) was found to suffer from this infection. Moreover, patients affected by active PV B19 infection showed viral loads not exceeding 1 × 105 genome copies/reaction. In conclusion, in this study, PV B19 infection was not common in renal transplant population and wasn't associated with severe anemia.

Risk Factors for Immediate Anemia in Renal Transplant Recipients: A Single-Center Experience

Background Although endogenous erythropoietin secretion returns via the renal allograft a few hours following successful engraftment, anemia is a common early or late complication. In addition, anemia is a risk factor for ischemic heart disease and graft loss. We sought to determine risk factors for and the prevalence of severe anemia immediately posttransplantation (PTA). Methods This cross-sectional retrospective study performed between 2006 and 2009 enrolled 864 adult subjects of mean age 40.7 ± 13.8 (range = 6–75) years. On the basis of The World Health Organization criteria, a hemoglobin (Hb) level less than 11 g/dL for men and less than 10 g/dL for women was defined as severe anemia. Results Severe anemia occurred frequently (62.7%) among these patients whose most common underlying disease was hypertension 311 (58.2%). Their mean Hb level was 9.9 ± 1.8 g/dL at the time of hospital discharge, namely, almost 2 weeks after transplantation. More than 90% ( n = 778) of subjects received a kidney from a living donor. Immediate severe anemia associated with delayed graft function (DGF; P = .01), antithymocyte globulin (ATG)/antilymphocyte globulin (ALG) administration ( P = .000), acute rejection ( P = .000), recipient gender ( P = .000), cold ischemic time ( P = .01), pretransplant Hb ( P = .000), posttransplant creatinine ( P = .001), and acute rejection episodes ( P = .000). Upon logistic regression analysis donor age ( P = .04, confidence interval [CI] = 0.7–0.9), recipient female gender ( P = .009, CI = 0.08–0.7), and ATG/ALG use ( P = .009, CI = 1.7–43.4) showed significant effects to cause severe PTA. Conclusion Immediate anemia after renal transplantation is a consequence of poor renal function. In addition, ATG/ALG use and DGF can induce severe PTA, which may play roles in ischemic heart disease and graft loss.

Anemia in Renal Transplant Recipients

Anemia in Renal Transplant Recipients

228: Effect of Sirolimus Versus Mycophenolate Mofetil on the Efficacy of Darbepoetin Alfa on Anemia in Renal Transplant Recipients

228: Effect of Sirolimus Versus Mycophenolate Mofetil on the Efficacy of Darbepoetin Alfa on Anemia in Renal Transplant Recipients

Anemia, Renal Transplantation, and the Anemia Paradox

Anemia is prevalent in renal transplant recipients (RTRs), as it is in all chronic kidney disease (CKD) populations. Mild anemia occurs in up to 40% of RTRs, and more severe anemia (110 g/L) occurs in about 9% to 22% of patients. As in CKD, impaired graft (renal) function is a major predictor of anemia identified in nearly all studies, suggesting a major role for erythropoietin deficiency. Chronic inflammation, malnutrition, iron deficiency, and medications (angiotensin converting enzyme inhibitors, angiotensin receptor blockers, mycophenolate, azathioprine, and sirolimus) are contributory factors seen in some, but not all, studies. Although pathophysiologic and observational data strongly support a causal association between low hemoglobin levels and cardiovascular outcomes in RTRs, no randomized controlled trial to date has been able to show a clear benefit of anemia treatment on cardiovascular outcomes or mortality in either RTR or other CKD populations. This important paradox has led some investigators to question the causal nature of the association between anemia and heart disease. Resolution of this paradox, at least for patients with stage 2/3 CKD, will depend on the outcome of randomized controlled trials currently in progress. Similar trials sorely are needed in renal transplant populations. In the interim, current opinion favors treating persistent anemia in RTRs to achieve targets similar to those recommended for dialysis and CKD patients.

Prevalence and Etiology of Anemia in Renal Transplant Recipients

We aimed to define the prevalence of anemia and possible causes for it in a group of renal transplant recipients. A total of 229 recipients (65 women; age 36.1 ± 11.8 years; minimum posttransplant duration, 3 years) were included. Patients with iron, vitamin B 12, and folic acid deficiencies were excluded. Patients were grouped according to number of posttransplant years completed with functioning grafts (3, 5, or 10 years). Demographic data, donor information, HLA mismatches, acute rejection episodes, biochemical parameters, and medications recieved during the 3 months before transplant and at 3, 5, and 10 years posttransplant were collected retrospectively. The anemia threshold was 13 g/dL for men and 12 g/dL for women. Anemia prevalence was 41.5%, 35.3%, and 93.2% at 3, 5, and 10 years, respectively. Anemic patients had higher creatinine levels for all years. In the anemic patients, hemoglobin values were lower in the pretransplant period than at 3 and 5 years. Anemic patients had higher HLA mismatches for the same years. Three-year hemoglobin levels were positively correlated with pretransplant hemoglobin and negatively correlated with creatinine levels and HLA mismatches. Five-year hemoglobin levels were positively correlated with pretransplant hemoglobin and albumin levels. Ten-year hemoglobin levels were positively correlated with pretransplant hemoglobin and albumin values but negatively correlated with creatinine levels and HLA mismatches. The prevalence of anemia in renal transplant recipients increases in parallel with posttransplant duration. Hemoglobin levels in these patients are closely related with pretransplant hemoglobin, follow-up creatinine levels, and HLA mismatches.

Influence of the Current Management of Renal Transplant Recipients on the Prevalence of Anemia and Related Costs

The use of mycophenolate mofetil (MMF) and renin-angiotensin system blockers (RAB) to prevent and treat chronic graft nephropathy may affect the incidence of anemia in renal transplant recipients. We compared 2 sets of cadaver-donor recipients, namely those followed at the end of 1995 (group 1; n = 252) versus 2003 (group 2; n = 530) in terms of general characteristics, incidence of anemia (hemoglobin [Hb] ≤13 g/L males, 12 g/L females) or severe anemia (Hb ≤11 g/L males, 10 g/L females) and use cost of treatment with erythropoietin (EPO). Group 2 was significantly older, heavier and longer since grafting. Fifty-seven percent received MMF, 21% received azathioprine, and 5% received rapamycin. In group 1, 83% were given azathioprine. RAB were administered to 35.1% in group 2 versus 14.7% in group 1 ( P < .001). Mean blood pressure was identical in the 2 groups, but graft function was worse in group 2 (Cockroft, 62 vs 74 mL/min; P < .001). Mean Hb levels (13.66 + − 3.1 vs 13.82 + − 1.7 g/L) and prevalence of anemia (36.9% vs 34.5%) for groups 1 and 2, respectively, were similar. The rate of severe anemia, however, was lower in group 2 (2.3% vs 8.7%; P < .001). The use of EPO increased from 2.8% (group 1) to 8.7% (group 2; P < .01). In 2003, the cost of EPO was calculated at 1982 euros/patient-year and 91,150 euros per year for the whole patient group. Despite accumulation of predisposing factors, the control of anemia in our patients has improved due to the expanded use of EPO. Along with its high cost, EPO therapy has potential positive repercussions on the quality of life and patient prognosis. Therefore, we need to precisely define the optimal use of EPO in renal transplant recipients.

A Retrospective Assessment of Pre‐Treatment Variables on the Response to Darbepoetin Alfa After Renal Transplantation

This retrospective review assesses the efficacy of darbepoetin alfa for treating anemia after renal transplantation. Patients were evaluated over a 12-week period, and efficacy was based on achieving hemoglobin >12 g/dL. Thirty-six patients were analyzed (53% male, 53% cadaveric allografts, median age 42.5 years). Baseline creatinine clearance ranged from approximately 15 to >100 mL/min. Most patients initiated darbepoetin alfa <3 months (50%) or >12 months (44%) after transplantation, 19% were previously receiving recombinant human erythropoietin (rHuEPO), and 47% were on concomitant ACE inhibitors. The majority of patients received either tacrolimus- (53%) or cyclosporine- (44%) based immunosuppression. Overall, 29 (81%) patients achieved the hemoglobin target with a mean time to response of 4.4 weeks. Neither the time to anemia onset, previous rHuEPO therapy, concomitant ACE inhibitor, allograft source, immunosuppressive regimen, nor degree of renal function affected the proportion of patients achieving the hemoglobin target, time to response or darbepoetin alfa dose requirement. Patients with anemia >12 months post-transplantation or on concomitant ACE inhibitors required a significantly longer duration of therapy. No adverse events associated with darbepoetin alfa therapy were detected. These results demonstrate that darbepoetin alfa is a safe and effective treatment for anemia in renal transplant recipients.

Benefits of Erythropoietin in Renal Transplantation

Anemia is a common complication in patients with chronic kidney diseases (CKD), including transplanted patients. Recent studies have found a prevalence of anemia of about 30%, whereas less than 10% of these patients received recombinant human erythropoietin. Factors explaining this high incidence of anemia in renal transplant recipients include delayed and impaired graft function and use of drugs inhibiting the action of angiotensin II and preventing rejection. Like in CKD patients, chronic anemia may impact on the cardiovascular system and finally on the high mortality of these patients. Recent data suggest also that anemia may be a factor of progression of renal dysfunction in kidney transplant recipients. A French randomized multicenter study was designed to answer this question.

Sodium ferric gluconate for post‐transplant anemia in pediatric and young adult renal transplant recipients

Post-transplant anemia is a widespread problem among pediatric renal transplant recipients. Many clinicians treat post-transplant anemia in a manner similar to treatment of anemia in dialysis patients, including the use of intravenous iron, such as sodium ferric gluconate (SFG). Data on pediatric dosing of SFG are limited to rare small series containing few or no renal transplant recipients. We conducted a retrospective chart review of practice patterns at our institution to evaluate doses used, hemoglobin response and adverse events. We identified 15 renal transplant recipients who received SFG during the 28-month study period. Data from 14 of these patients were available for analysis. Patients received between one and six doses of SFG to yield a total dose of 100-1000 mg or 2.7-23.7 mg/kg. The largest doses given during a single infusion ranged from 1.9 to 6.4 mg/kg. The mean hemoglobin level increased from 101 +/- 16 to 114 +/- 21 g/L (p = 0.0092) following SFG therapy. Adverse events were recorded for three patients. Treatment with SFG appears to yield some improvement in anemia in renal transplant recipients, but the paucity of published information on this topic highlights the need for stronger data, particularly with respect to pediatric patients.

Causes of anemia in renal transplant recipients

Iron-deficiency anemia is one of the major problems encountered in renal transplant recipients. The aim of this retrospective study was to reevaluate the causes of anemia among 100 anemic kidney recipients. Patients with serum creatinine levels greater than 2 mg/dL were excluded from the study. Female patients were considered to be anemic if the hemoglobin was <12 g/dL for males, <13 g/dL. Complete blood count, serum creatinine, serum iron, iron-binding capacity, ferritin, transferrin saturation, erythrocyte folate, and serum vitamin B12 levels were measured in all patients. Mean hemoglobin value was 10.2 ± 1.4 g/dL for female and 9.9 ± 1.3 for male patients, mean corpuscular volume (MCV) 91.3 ± 4.9 fL. We observed normocytic anemia in 60, macrocytic anemia in 30, and microcytic anemia in 10 patients. A low level of serum folate was observed in 9 (15%) and of vitamin B12 in 5 (8.8%) of 60 patients with normocytic anemia. Folate deficiency was found in 18 (60%) and vitamin B12 deficiency in 12 (40%) of 30 patients with macrocytic anemia. All patients with microcytic anemia had iron deficiency. Splenomegaly was seen significantly more often in patients with macrocytic than normocytic anemia (P = .008). Folate and vitamin B12 deficiency were the major causes of nutritional anemia; oral or parenteral supplementation with these vitamins is likely to cure the anemia in the majority of cases.

Prevalence and Management of Anemia in Renal Transplant Recipients: A European Survey

The TRansplant European Survey on Anemia Management (TRESAM) documented the prevalence and management of anemia in kidney transplant recipients. Data from 72 transplant centers in 16 countries were screened, involving 4263 patients who had received transplants 6 months, 1, 3 or 5 years earlier. The mean age of transplant recipients was 45.5 years at transplantation. The most common etiology was chronic glomerulonephritis. The most common comorbidities were coronary artery disease, hepatitis B/C, and type 2 diabetes. The mean hemoglobin levels before transplantation were significantly higher in the more recently transplanted recipients. At enrollment, 38.6% of patients were found to be anemic. Of the 8.5% of patients who were considered severely anemic, only 17.8% were treated with epoetin. There was a strong association between hemoglobin and graft function; of the 904 patients with serum creatinine > 2 mg/dL, 60.1% were anemic, vs. 29.0% of those with serum creatinine <or= 2 mg/dL (p < 0.01). Therapy with angiotensin-converting enzyme (ACE) inhibitors, angiotensin II receptor antagonists, mycophenolate mofetil (MMF) or azathioprine was also associated with a higher likelihood of anemia. The prevalence of anemia in the transplant recipients was remarkably high and appeared to be associated with impaired renal function and with ACE inhibitors and angiotensin II receptor antagonist use. Further studies should be carried out to interpret whether appropriate management of anemia after kidney transplantation may improve long-term outcome.