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Published on: September 6, 2017
Anemia is a predictor of outcome in heart transplant recipients
P Przybylowski1, J Malyszko, J Malyszko
1Department of Cardiac Surgery and Transplantology, Collegium Medicum, Jagiellonian University, Pradnicka 80, Cracow, Poland. piotrus@aol.com
Insights
Anemia is common after heart transplants, affecting 41% of patients. Poor kidney function is the main cause, increasing cardiovascular risks.
Area of Science:
- Nephrology
- Cardiology
- Transplantation Medicine
Background:
- Cardiovascular and kidney diseases share pathophysiological links.
- Anemia is increasingly recognized in cardiovascular disease patients, often linked to kidney dysfunction, termed cardiorenal anemia syndrome.
Purpose of the Study:
- To determine the prevalence of anemia in patients following orthotopic heart transplantation.
- To investigate the relationship between anemia and chronic kidney disease indicators in this population.
Main Methods:
- Assessed anemia using World Health Organization criteria (hemoglobin <13 g/dL males, <12 g/dL females).
- Evaluated 160 patients post-orthotopic heart transplantation.
- Calculated glomerular filtration rate (GFR) using Modification of Diet in Renal Disease and Cockcroft-Gault formulas.
Main Results:
- 41% of heart transplant recipients had anemia.
- Anemic patients showed significantly lower GFR, creatinine clearance, red blood cell count, hemoglobin, and ejection fraction.
- Anemia was associated with time since transplantation, GFR, creatinine clearance, N-terminal probrain natriuretic peptide, cholesterol, and ejection fraction.
- Kidney function (GFR or creatinine clearance) was the sole predictor of anemia, explaining 22% of the variation.
Conclusions:
- Anemia is highly prevalent in heart allograft recipients and often undertreated.
- Estimating GFR is crucial in cardiovascular disease patients due to renal dysfunction and anemia being significant risk factors for morbidity and mortality.
- Anemia is linked to increased prevalence of chronic heart failure.
Background:
Cardiovascular disease and kidney disease share similar characteristics. It has been recently recognized that many patients with cardiovascular disease have anemia, which often is associated with kidney dysfunction. Even the term "cardiorenal anemia syndrome" was endorsed to stress the dangerous association.
Objective:
To assess the prevalence of anemia in relation to chronic kidney disease in 160 patients after orthotopic heart transplantation.
Results:
According to the World Health Organization definition of anemia (hemoglobin concentration <13 g/dL in males and <12 g/dL in females), 41% of our patients had anemia. Patients with anemia exhibited a significantly lower mean (SD) glomerular filtration rate (GFR) using the Modification of Diet in Renal Disease formula vs the Cockcroft-Gault formula: 44.46 (26.84) mL/min vs 62.70 (24.15) mL/min and 48.93 (27.80) mL/min vs 72.11 (29.76) mL/min, respectively (P < .001). In addition, they demonstrated lower creatinine clearance, red blood cell count, hemoglobin concentration, and ejection fraction and significantly higher creatinine and N-terminal probrain natriuretic peptide concentrations. Presence of anemia was associated with time since transplantation, GFR, creatinine clearance, N-terminal probrain natriuretic peptide and cholesterol concentrations, and ejection fraction. At multiple regression analysis, the only predictor of anemia was kidney function (GFR or creatinine clearance), which accounts for 22% of the variation. Type of immunosuppression regimen (calcineurin inhibitors vs mammalian target of rapamycin) did not seem to affect prevalence of anemia in the study population.
Conclusions:
The prevalence of anemia is relatively high in heart allograft recipients and is not adequately treated. In patients with cardiovascular disease, GFR should be estimated because renal dysfunction and subsequent anemia are important risk factors for cardiovascular morbidity and mortality. Chronic heart failure is also more common in patients with anemia.
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