5 Following successful kidney transplantation, with the rise in endogenous erythropoietin production, haemoglobin levels generally rise and normalize within the first two to 4 months.6 However, anaemia may persist after transplantation. The prevalence of anaemia has been found to
be as high as 38.6% in long-term kidney transplant recipients (ranging from 6 to 5 months post-transplant), including those patients with normal graft function.7–13 In kidney transplant recipients, anaemia is a significant independent risk factor for cardiovascular death and for all-cause mortality14,15 and a positive correlation exists between creatinine clearance and haemoglobin levels.16 While post-transplant anaemia is associated with treatment with azathioprine, sirolimus and mycophenolate mofetil, as well as angiotensin-converting enzyme learn more inhibitors (ACEi)
and angiotensin II receptor antagonists,17,18 nutritional factors appear to be potentially important in the aetiology and management of post-transplant anaemia. There may be a high prevalence of iron deficiency among kidney transplant recipients, in whom anaemia has not been diagnosed.14,19–21 Folate and B12 deficiencies may also contribute to anaemia in stable kidney transplant recipients.22 This review set out to explore and collate the evidence on the safety and efficacy of nutritional interventions in preventing and managing anaemia in kidney transplant recipients, based on the best evidence up to and including September 2006. Relevant reviews and studies were obtained from the sources this website below and reference lists of nephrology textbooks,
review articles and relevant trials were also used to locate studies. Searches were limited to studies on humans; adult kidney transplant recipients; single organ transplants and to studies published in English. Unpublished studies were not reviewed. Databases searched: Y-27632 2HCl MeSH terms and text words for kidney transplantation were combined with MeSH terms and text words for both anaemia and dietary interventions. Medline – 1966 to week 1, September 2006; Embase – 1980 to week 1, September 2006; the Cochrane Renal Group Specialised Register of Randomised Controlled Trials. Date of searches: 22 September 2006. There are no published studies of satisfactory quality examining the efficacy of specific dietary interventions in the management of anaemia in kidney transplant recipients. There is one randomized controlled trial examining the safety of concomitant oral iron supplementation and mycophenolate mofetil (MMF). Mudge et al.23 undertook an open-label, randomized, controlled trial in which new kidney transplant recipients were randomly allocated to either receive iron supplements with a morning dose of MMF; iron supplements given 4 h after MMF; or no iron supplements.