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Anemia in children following renal transplantation—results from the ESPN/ERA-EDTA Registry

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Abstract

Background

Our aim was to determine the prevalence of sub-target hemoglobin (Hb) levels in children with a renal allograft and to identify potential determinants associated with these Hb levels.

Methods

Data from 3669 children with a functioning renal allograft, aged <18 years between 1 January 2000 and 31 December 2012, from 20 European countries were retrieved from the ESPN/ERA-EDTA Registry, providing 16,170 Hb measurements.

Results

According to the NKF/KDOQI classification and the UK-NICE guidelines, 49.8 and 7.8 % of the patients, respectively, were anemic. Hb levels were strongly associated with graft function, with Hb levels of 12.6 g/dl in children with chronic kidney disease (CKD) stage 1, declining to 10.7 g/dl in children with CKD stage 5 (P < 0.001). Higher Hb levels were associated with the use of tacrolimus compared to ciclosporin (0.14 g/dl; 95 % confidence interval 0.02–0.27; P = 0.002). Low Hb levels were associated with an increased risk of graft failure (P = 0.01) or combined graft failure and death (P < 0.01), but not with death alone (not significant).

Conclusions

Anemia is present in a significant proportion of European pediatric kidney transplant recipients and is associated with renal allograft dysfunction and type of immunosuppressants used. In our patient cohort, higher Hb levels were associated with better graft and patient survival and less hypertension.

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Acknowledgments

We would like to thank the patients, their parents, and the staff of all the dialysis and transplant units who have contributed data via their national registries and contact persons. We also would like to thank R Coppo, D Haffner, J Harambat and C Stefanidis for being members of the ESPN/ERA-EDTA Registry Committee; D Shtiza, R Kramar, R Oberbauer, S Baiko, A Sukalo, K van Hoeck, F Collart, JM des Grottes, D Pokrajac, D Roussinov, D Batinić, M Lemac, J Slavicek, T Seeman, K Vondrak, JG Heaf, U Toots, P Finne, C Grönhagen-Riska, C Couchoud, M Lasalle, E Sahpazova, N Abazi, N Ristoka Bojkovska, G von Gersdorff, C Scholz, B Tönshoff, K Krupka, B Höcker, L Pape, N Afentakis, A Kapogiannis, N Printza, G Reusz, Cs Berecki, A Szabó, T Szabó, Zs Györke, E Kis, R Palsson, V Edvardsson, M Bonsano, R Chimenz, C Corrado, F Paglialonga, C Pecoraro, S Picca, E Vidal, A Jankauskiene, B Pundziene, V Said-Conti, S Gatcan, O Berbeca, N Zaikova, S Pavićević, T Leivestad, S Gatcan, O Berbeca, N Zaikova, S Pavićević, T Leivestad, A Bjerre, A Zurowska, I Zagozdzon, C Mota, M Almeida, C Afonso, G Mircescu, L Garneata, EA Molchanova, NA Tomilina, BT Bikbov, M Kostic, A Peco-Antic, B Spasojevic-Dimitrijeva, G Milosevski-Lomic, D Paripovic, S Puric, D Kruscic, L Podracka, G Kolvek, J Buturovic-Ponikvar, G Novljan, N Battelino, A Alonso Melgar, and the Spanish Pediatric Registry; S Schön, KG Prütz, L Backmän, M Stendahl, M Evans, B Rippe, CE Kuenhi, E Maurer, GF Laube, S Tschumi, P Parvex, A Hoitsma, A Hemke, and all centers participating in the RichQ study; R Topaloglu, A Duzova, D Ivanov, R Pruthi, F Braddon, S Mannings, A Cassula, and MD Sinha for contributing data to the ESPN/ERA-EDTA Registry.

Conflict of interest statement

The authors declare that there are no conflicts of interest.

Ethical approval

As this study is based on anonymized Registry data, ethical approval was not required.

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Author notes

    Authors and Affiliations

    1. Department of Paediatric Nephrology, Sydney Children’s Hospital, Sydney, Australia

      Leah A. Krischock

    2. ESPN/ERA-EDTA Registry, Department of Medical Informatics, Academic Medical Center, PO Box 22700, Amsterdam, The Netherlands

      Karlijn J. van Stralen, Marjolein Bonthuis & Kitty J. Jager

    3. G Gaslini Hospital, Genova, Italy

      Enrico Verrina

    4. Bristol Royal Hospital for Children, Bristol, UK

      E. Jane Tizard

    5. Semmelweis University Budapest, Budapest, Hungary

      György Reusz

    6. Nottingham University Hospitals, Nottingham, UK

      Farida K Hussain

    7. Vilnius University, Vilnius, Lithuania

      Augustina Jankauskiene

    8. Children’s Hospital University Medical Center, Ljubljana, Slovenia

      Gregor Novljan

    9. University Children Hospital, Belgrade, Serbia

      Brankica Spasojević-Dimitrijeva

    10. Department of Pediatrics, Faculty of Medicine, Slovak Medical University (SMU), Bratislava, Slovak Republic

      Ludmila Podracka

    11. Medical University of Vienna, Vienna, Austria

      Vera Zaller

    12. University of Heidelberg Center for Pediatrics and Adolescent Medicine, Heidelberg, Germany

      Franz Schaefer

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    1. Leah A. Krischock
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    on behalf of the ESPN/ERA-EDTA Registry

    Corresponding author

    Correspondence to Karlijn J. van Stralen.

    Additional information

    Leah A. Krischock and Karlijn J. van Stralen contributed equally to this work.

    This article was written by LA Krischock, KJ van Stralen, E Verrina, EJ Tizard, M Bonthuis, G Reusz, FK Hussain, A Jankauskiene, G Novljan, B Spasojević-Dimitrijeva, L Podracka, V Zaller, KJ Jager, F Schaefer on behalf of the ESPN/ERA-EDTA Registry and the ERA-EDTA Registry which is an official body of the ERA-EDTA (European Renal Association–European Dialysis and Transplant Association).

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    Krischock, L.A., van Stralen, K.J., Verrina, E. et al. Anemia in children following renal transplantation—results from the ESPN/ERA-EDTA Registry. Pediatr Nephrol 31, 325–333 (2016). https://doi.org/10.1007/s00467-015-3201-8

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