肾移植后贫血和缺铁:一个未解决的挑战。

IF 4.6 2区 医学 Q1 UROLOGY & NEPHROLOGY
Clinical Kidney Journal Pub Date : 2025-08-19 eCollection Date: 2025-09-01 DOI:10.1093/ckj/sfaf252
Jose Portolés, Rainer Oberbauer, Michele F Eisenga, Aleix Cases, Jolanta Małyszko, Gabriel Choukroun, Marta Crespo, Kai-Uwe Eckardt, Roberto Minutolo
{"title":"肾移植后贫血和缺铁:一个未解决的挑战。","authors":"Jose Portolés, Rainer Oberbauer, Michele F Eisenga, Aleix Cases, Jolanta Małyszko, Gabriel Choukroun, Marta Crespo, Kai-Uwe Eckardt, Roberto Minutolo","doi":"10.1093/ckj/sfaf252","DOIUrl":null,"url":null,"abstract":"<p><p>Anemia and iron deficiency (ID) are common and significant complications in kidney transplant recipients (KTRs) that can affect their health-related quality of life (HRQoL) and outcomes. Current anemia guidelines equate the post-transplant situation with the anemia associated with chronic kidney disease (CKD) in non-transplanted persons, not acknowledging relevant differences ranging from pathophysiology to clinical manifestation. Nephrologists caring for these patients tend to pay less attention to post-transplant anemia (PTA) and ID than in non-transplanted persons with CKD. In this narrative review we summarize the available evidence about PTA and ID and their specifics in KTRs, including associations with patient and graft survival and poorer HRQoL. The prevalence of anemia is higher in KTRs than in non-transplanted patients with CKD for a given level of glomerular filtration rate (GFR) due to kidney transplant (KT)-specific pathophysiological factors. ID should be detected and corrected in KTRs using oral or intravenous (IV) iron. Some IV iron formulations are associated with an increased risk of hypophosphatemia a typical complication in KTRs. Current guidelines suggest the same hemoglobin targets for erythropoiesis stimulating agent therapy in transplanted and non-transplanted patients, despite the fact that a higher hemoglobin target has been associated with a slower estimated GFR decline in KT. There are insufficient data to recommend the widespread use of hypoxia-inducible factor-prolyl-hydroxylase inhibitors in PTA. Red blood cell transfusions should be avoided to minimize alosensitization. We call for increased awareness and targeted trials on anemia and ID in KTRs, accounting for the diverse and specific profiles of these patients.</p>","PeriodicalId":10435,"journal":{"name":"Clinical Kidney Journal","volume":"18 9","pages":"sfaf252"},"PeriodicalIF":4.6000,"publicationDate":"2025-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12415517/pdf/","citationCount":"0","resultStr":"{\"title\":\"Anemia and iron deficiency in post-kidney transplantation: an unsolved challenge.\",\"authors\":\"Jose Portolés, Rainer Oberbauer, Michele F Eisenga, Aleix Cases, Jolanta Małyszko, Gabriel Choukroun, Marta Crespo, Kai-Uwe Eckardt, Roberto Minutolo\",\"doi\":\"10.1093/ckj/sfaf252\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><p>Anemia and iron deficiency (ID) are common and significant complications in kidney transplant recipients (KTRs) that can affect their health-related quality of life (HRQoL) and outcomes. Current anemia guidelines equate the post-transplant situation with the anemia associated with chronic kidney disease (CKD) in non-transplanted persons, not acknowledging relevant differences ranging from pathophysiology to clinical manifestation. Nephrologists caring for these patients tend to pay less attention to post-transplant anemia (PTA) and ID than in non-transplanted persons with CKD. In this narrative review we summarize the available evidence about PTA and ID and their specifics in KTRs, including associations with patient and graft survival and poorer HRQoL. The prevalence of anemia is higher in KTRs than in non-transplanted patients with CKD for a given level of glomerular filtration rate (GFR) due to kidney transplant (KT)-specific pathophysiological factors. ID should be detected and corrected in KTRs using oral or intravenous (IV) iron. Some IV iron formulations are associated with an increased risk of hypophosphatemia a typical complication in KTRs. Current guidelines suggest the same hemoglobin targets for erythropoiesis stimulating agent therapy in transplanted and non-transplanted patients, despite the fact that a higher hemoglobin target has been associated with a slower estimated GFR decline in KT. There are insufficient data to recommend the widespread use of hypoxia-inducible factor-prolyl-hydroxylase inhibitors in PTA. Red blood cell transfusions should be avoided to minimize alosensitization. We call for increased awareness and targeted trials on anemia and ID in KTRs, accounting for the diverse and specific profiles of these patients.</p>\",\"PeriodicalId\":10435,\"journal\":{\"name\":\"Clinical Kidney Journal\",\"volume\":\"18 9\",\"pages\":\"sfaf252\"},\"PeriodicalIF\":4.6000,\"publicationDate\":\"2025-08-19\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12415517/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Clinical Kidney Journal\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1093/ckj/sfaf252\",\"RegionNum\":2,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2025/9/1 0:00:00\",\"PubModel\":\"eCollection\",\"JCR\":\"Q1\",\"JCRName\":\"UROLOGY & NEPHROLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Clinical Kidney Journal","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1093/ckj/sfaf252","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/9/1 0:00:00","PubModel":"eCollection","JCR":"Q1","JCRName":"UROLOGY & NEPHROLOGY","Score":null,"Total":0}
引用次数: 0

摘要

贫血和缺铁(ID)是肾移植受者(KTRs)常见且重要的并发症,可影响其健康相关生活质量(HRQoL)和预后。目前的贫血指南将移植后的情况等同于未移植患者的慢性肾脏疾病(CKD)相关贫血,没有认识到从病理生理到临床表现的相关差异。与未移植的CKD患者相比,护理这些患者的肾病学家往往较少关注移植后贫血(PTA)和ID。在这篇叙述性综述中,我们总结了关于PTA和ID的现有证据及其在KTRs中的特点,包括与患者和移植物存活以及较差HRQoL的关系。由于肾移植(KT)特异性病理生理因素导致肾小球滤过率(GFR)达到一定水平,ktr患者的贫血患病率高于未移植的CKD患者。在KTRs中,应使用口服或静脉(IV)铁检测和纠正ID。一些IV铁制剂与低磷血症的风险增加有关,这是ktr的典型并发症。目前的指南建议在移植和非移植患者中使用相同的促红细胞生成药物治疗的血红蛋白靶点,尽管事实上较高的血红蛋白靶点与估计的KT GFR下降较慢相关。没有足够的数据推荐在PTA中广泛使用缺氧诱导因子-脯氨酸羟化酶抑制剂。应避免红细胞输注,以尽量减少过敏。考虑到这些患者的多样性和特殊性,我们呼吁提高对ktr患者贫血和ID的认识并进行有针对性的试验。
本文章由计算机程序翻译,如有差异,请以英文原文为准。

Anemia and iron deficiency in post-kidney transplantation: an unsolved challenge.

Anemia and iron deficiency in post-kidney transplantation: an unsolved challenge.

Anemia and iron deficiency in post-kidney transplantation: an unsolved challenge.

Anemia and iron deficiency in post-kidney transplantation: an unsolved challenge.

Anemia and iron deficiency (ID) are common and significant complications in kidney transplant recipients (KTRs) that can affect their health-related quality of life (HRQoL) and outcomes. Current anemia guidelines equate the post-transplant situation with the anemia associated with chronic kidney disease (CKD) in non-transplanted persons, not acknowledging relevant differences ranging from pathophysiology to clinical manifestation. Nephrologists caring for these patients tend to pay less attention to post-transplant anemia (PTA) and ID than in non-transplanted persons with CKD. In this narrative review we summarize the available evidence about PTA and ID and their specifics in KTRs, including associations with patient and graft survival and poorer HRQoL. The prevalence of anemia is higher in KTRs than in non-transplanted patients with CKD for a given level of glomerular filtration rate (GFR) due to kidney transplant (KT)-specific pathophysiological factors. ID should be detected and corrected in KTRs using oral or intravenous (IV) iron. Some IV iron formulations are associated with an increased risk of hypophosphatemia a typical complication in KTRs. Current guidelines suggest the same hemoglobin targets for erythropoiesis stimulating agent therapy in transplanted and non-transplanted patients, despite the fact that a higher hemoglobin target has been associated with a slower estimated GFR decline in KT. There are insufficient data to recommend the widespread use of hypoxia-inducible factor-prolyl-hydroxylase inhibitors in PTA. Red blood cell transfusions should be avoided to minimize alosensitization. We call for increased awareness and targeted trials on anemia and ID in KTRs, accounting for the diverse and specific profiles of these patients.

求助全文
通过发布文献求助,成功后即可免费获取论文全文。 去求助
来源期刊
Clinical Kidney Journal
Clinical Kidney Journal Medicine-Transplantation
CiteScore
6.70
自引率
10.90%
发文量
242
审稿时长
8 weeks
期刊介绍: About the Journal Clinical Kidney Journal: Clinical and Translational Nephrology (ckj), an official journal of the ERA-EDTA (European Renal Association-European Dialysis and Transplant Association), is a fully open access, online only journal publishing bimonthly. The journal is an essential educational and training resource integrating clinical, translational and educational research into clinical practice. ckj aims to contribute to a translational research culture among nephrologists and kidney pathologists that helps close the gap between basic researchers and practicing clinicians and promote sorely needed innovation in the Nephrology field. All research articles in this journal have undergone peer review.
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
确定
请完成安全验证×
copy
已复制链接
快去分享给好友吧!
我知道了
右上角分享
点击右上角分享
0
联系我们:info@booksci.cn Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。 Copyright © 2023 布克学术 All rights reserved.
京ICP备2023020795号-1
ghs 京公网安备 11010802042870号
Book学术文献互助
Book学术文献互助群
群 号:604180095
Book学术官方微信