Böbrek Nakli Olan Çocuklarda Aneminin Sıklığı ve Risk Faktörleri

Year 2014, Volume: 8 Issue: 1, 12 - 16, 01.12.2014

İpek Kaplan Bulut Nida Dinçel Mustafa Orhan Bulut Betül Sözeri Kadriye Özdemir Mehmet Fatih Orhan Sevgi Mir

Abstract

Amaç: Renal transplantlı hastaların takibinde anemi yaygın görülmektedir. Renal transplantlı çocuklarda görülen anemi hakkında yeterli bilgi bulunmamaktadır.Bu çalışmanın amacı; transplantasyon sonrası çocuklarda kısa ve uzun dönemde ortaya çıkan aneminin risk faktörlerini ve prevalansını değerlendirmektir.Gereç ve Yöntemler: Bu çalışma, Ege Üniversitesi’ndeki böbrek nakilli çocuklarda yapılmıştır. Hematokrit düzeyinin yaşa göre 2 standart deviasyon altında olması anemi olarak tanımlanmıştır.Bulgular: Erken post transplant dönemde anemi insidansı %18 bulundu. Geç post transplant dönemde ortalama olarak 60 ayda %27.5 oranda anemi saptandı. Anemi insidansı post transplant 24.36,48 ve 60. aylarda sırasıyla %18.4, %23.3, %23 ve %27.5 bulundu. Takip süresince herhangi bir zamanda 71 (%67.6) hastada en az bir kez anemi tespit edildi. Transplantasyon sonrası herhangi bir dönemde kullanılan ACE inhibitörü ile anemi arasında ilişki saptanmadı. Donör tipi ve yaşı ile geç anemi arasında anlamlı bir ilişki bulunmadı. Diğer yandan, geç dönem anemi rejeksiyon öyküsüyle anlamlı ilişkili bulundu.Sonuç: Renal transplant alıcısı olan çocuklarda tahmini glomerül filtrasyon hızının düşüklüğü, transplantasyon sonrası sürenin uzunluğu ve rejeksiyon atağı anemi için risk faktörleridir.

Keywords

Anemi, Çocuk, Renal transplantasyon

The Prevalence and Risk Factors of Anemia in Children with Renal he Prevalence and Risk Factors of Anemia in Children with Renal Transplant

Abstract

Objective: Anemia is commonly observed during the follow-ups of patients with renal transplantation. There is not enough information on anemia observed in children with renal transplantation. The aim of this study was to evaluate the prevalence and risk factors of anemia in children with renal transplantation on the short and long-term posttransplantation period.Material and Methods: This study was performed in children who underwent renal transplant at Ege University. Anemia was defi ned as having a value less than 2 Standard Deviation for hematocrit levels according to age.Results: In the early post-transplant period, the incidence of anemia was found as 18%. Late post transplant anemia rate was detected as 27.5% at 60 months. The incidence of anemia was 18.4%, 23.3%, 23% and 27.5%, at 24, 36, 48 and 60 months after transplantation, respectively. Anemia was detected at least once in 71 (67.6%) patients at any point of the follow-up period. There was no correlation between Angiotensin Converting Enzyme inhibitor therapy and anemia at any post-transplant time. Donor type and donor age were not signifi cantly associated with late anemia. On the other hand, late anemia was signifi cantly associated with a history of rejection. Conclusion: Low estimated Glomerular Filtration Rate, longer duration of post-transplantation and rejection attacks are the risk factors for anemia in pediatric renal transplant recipients

Keywords

Anemia, Children, Renal transplantation

References

• Vanrenterghem Y, Ponticelli C, Morales JM, Abramowicz D, Baboolal K, Eklund B, et al. Prevalence and management of anemia in renal transplant recipients: A European survey. Am J Transplant 2003;3:835-45.
• Laupacis A, Keown P, Pus N, Krueger H, Ferguson B, Wong C, et al. A study of the quality of life and cost-utility of renal transplantation. Kidney Int 1996;50:235-42.
• Muirhead N. Erythropoietin and renal transplantation. Kidney Int 1999;69:86–92.
• Borrows R, Loucaidou M, Chusney G, Borrows S, Tromp JV, Cairns T, et al. Anemia and congestive heart failure early post-renal transplantation. Nephrol Dial Transplant 2008;23:1728-34.
• Moore LW, Smith SO, Winsett RP, Acchiardo SR, Gaber AO. Factors affecting erythropoietin production and correction of anemia in kidney transplant recipients. Clin Transplant 1994;8: 358-64.
• Shibagaki Y, Shetty A. Anemia is common after kidney transplantation, especially among African Americans. Nephrol Dial Transplant 2004;19:2368-73.
• Al-Khoury S, Shah N, Afzali B, Covic A, Taylor J, Goldsmith D. Post-transplantation anemia in adult and pediatric renal allograft recipients-Guy’s Hospital experience. Nephrol Dial Transplant 2006;21:1974-80.
• Kasiske BL, Guijarro C, Massy ZA, Wiederkehr MR, Ma JZ. Cardiovascular disease after renal transplantation. J Am Soc Nephrol 1996;7:158-65.
• Ternero F, Prats D, Alvarez-Sala JL, Coronel F, Sanchez A, Barrientos A. Iron defi ciency anemia after successful renal transplantation. J Urol 1993;149:1398-400.
• Miles AM, Markell MS, Daskalakis P, Sumrani NB, Hong J, Sommer BG, et al. Anemia following renal transplantation. Erythropoietin response and iron defi ciency. Clin Transplant 1997;11:313-5.
• Kasiske BL, Vazquez MA, Harmon WE, Brown RS, Danovitch GM, Gaston RS, et al. Recommendations for the outpatient surveillance of renal transplant recipients: American Society of Transplantation. J Am Soc Nephrol 2000;11:1-86.
• Lorenz M, Kletzmayr J, Perschl A, Furrer A, Hörl WH, Sunder- Plassmann GJ. Anemia and iron defi ciencies among long-term renal transplant recipients. Am Soc Nephrol 2002;13:794-7.
• Yorgin PD, Belson A, Sanchez J, Al Uzri AY, Sarwal M, Bloch DA, et al. Unexpectedly high prevalence of post transplant anemia in pediatric and young adult renal transplant recipients. Am J Kidney Dis 2002;40:1306-18.
• Cockcroft DW, Gault MH. Prediction of creatinine clearance from serum creatinine. Nephron 1976;16:31-41.
• Al-Uzri A, Yorgin PD, Kling PJ. Anemia in children after transplantation: Etiology and the effect of immunosuppressive therapy on erythropoiesis. Pediatr Transplantation 2003;7:253-64.
• Kausman JY, Powell HR, Jones CL. Anemia in pediatric renal transplant recipients. Pediatr Nephrol 2004;19:526-30.
• Banaga AS, Yousif ME, Elmusharaf K. Risk factors of post renal transplant anemia among Sudanese patients, a study in three renal transplant centers. BMC Nephrol 2011;12:37.
• Moulin B, Ollier J, George F, Purgus R, Roux F, Sampol J, et al. Serum erythropoietin and reticulocyte maturity index after renal transplantation: A prospective longitudinal study. Nephron 1995; 69:259-66.
• Chua MS, Barry C, Chen X, Salvatierra O, Sarwal MM. Molecular profi ling of anemia in acute renal allograft rejection using DNA microarrays. Am J Transplant 2003;3:17-22.
• Fernández Fresnedo G, Palomar R, Rodrigo E, Ruiz JC, de Francisco AL, Cotorruelo JG, et al. Prevalence of anemia in renal transplant patients: Results from MOST, an observational trial. Transplant Proc 2005;37:3821-2.
• Gentil MA, Pérez-Valdivia MA, López-Mendoza M, Ortega F, Arias M, Gómez-Alamillo C, et al. Factor defi ciency in the anemia of renal transplant patients with grade III-IV chronic kidney disease: Baseline results of the ARES Study. Transplant Proc 2008;40:2922-4.
• Shah N, Al-Khoury S, Afzali B, Covic A, Roche A, Marsh J, et al. Post transplantation anemia in adult renal allograft recipients: Prevalence and predictors. Transplantation 2006;81:1112-8.
• Turkowski-Duhem A, Kamar N, Cointault O, Lavayssiere L, Ribes D, Esposito L, et al. Predictive factors of anemia within the fi rst year post renal transplant. Transplantation 2005;80:903-9
• Naito M, Kawashima A, Akiba T, Takanashi M, Nihei H. Effects of an angiotensin II receptor antagonist and angiotensin-converting enzyme inhibitors on burst forming units-erythroid in chronic hemodialysis patients. Am J Nephrol 2003;23:287-93.
• Le Meur Y, Lorgeot V, Comte L, Szelag JC, Aldigier JC, Leroux- Robert C, et al. Plasma levels and metabolism of AcSDKP in patients with chronic renal failure: Relationship with erythropoietin requirements. Am J Kidney Dis 2001;38:510-17.
• Sinnamon KT, Courtney AE, Maxwell AP, McNamee PT, Savage G, Fogarty DG. Level of renal function and serum erythropoietin levels independently predict anemia post-renal transplantation. Nephrol Dial Transplant 2007;22:1969-73.