Saudi Journal of Kidney Diseases and Transplantation

LETTER TO THE EDITOR
Year
: 2013  |  Volume : 24  |  Issue : 2  |  Page : 367--369

Author's reply


Dawlat Sany 
 Assistant Professor, Division of Nephrology, Ain-Shams University, Cairo, Egypt

Correspondence Address:
Dawlat Sany
Assistant Professor, Division of Nephrology, Ain-Shams University, Cairo
Egypt




How to cite this article:
Sany D. Author's reply.Saudi J Kidney Dis Transpl 2013;24:367-369


How to cite this URL:
Sany D. Author's reply. Saudi J Kidney Dis Transpl [serial online] 2013 [cited 2020 Feb 25 ];24:367-369
Available from: http://www.sjkdt.org/text.asp?2013/24/2/367/109606


Full Text

To the Editor,

First, we thank Dr. Zohreh Rostami for his interest in reading and commenting on our manuscript entitled "Prevalence and association of post-renal transplant anemia." Whenever an original paper deserves such a letter, authors are happy and honored to give their opinions. Many studies pointed out the prevalence of post-transplant anemia (PTA) in developed countries. A Japanese study concluded that the prevalence of PTA is 20%, [1] and a big multicenter study conducted in 72 centers in 16 European countries [Transplant European Survey on Anemia Management (TRESAM)] concluded that the prevalence of PTA was 38.6%. [2] In a published British study, the prevalence of anemia was 53% at 12 months from the kidney transplantation. [3] A Turkish study concluded that prevalence of PTA was 49.3%, [4] and in Austria, PTA was present in 39.7%. [5] Among Hungarians, PTA was present in 33.8%. [6] In our study, [7] the prevalence of anemia was 45% at six months after transplantation. Zohreh Rostami et al found a high prevalence of PTA (53%) among 2713 adult renal transplant recipients (RTRs), and the prevalence of severe anemia (according to the World Health Organization criteria, a hemoglobin level of less than 11 g/dL for men and less than 10 g/dL for women was defined as severe anemia) was 24%. [8] This large variability is at least partly explained by differences in diagnostic criteria of anemia, age, race, and interval since transplantation. Current research is mainly focused on anemia, persisting three to six months after transplantation, with a distinction made between early (between three and six months) and late (more than six months) PTA. Less is known about the prevalence and pathophysiology of anemia within the first three months after renal transplantation (further referred to as immediate PTA), especially in the developing countries. Our study demonstrated that high serum creatinine level, female gender, delayed graft function, acute rejection, and infection were the only independent risk factors for anemia in early renal transplant. Renal dysfunction is strongly associated with the development of PTA [2] and considered as a major risk factor; other factors such as rejection, [9],[10] recent infection, [11],[12],[13],[14] longer duration of transplantation, [15] immunosuppressive treatments, [3],[16],[17],[18],[19],[20],[21],[22],[23] use of angiotensin converting enzyme inhibitors/angiotensin receptors blockers (ACEI/ARB), [2],[24],[25] low serum albumin, [4] protein energy waste syndrome, [26] and old age of the kidney donor [2] are all considered as risk factors for the development of PTA. We feel that it would be more appropriate for questions to be addressed by a future study, with sufficient number of patients, different age groups, different races, and with different contributing factors to provide clear guidelines for management of anemia post renal transplant.

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