- 作者：Gabriel Choukroun ; Gilbert Deray ; Denis Glotz ; Yvon Lebranchu ; Bertr ; Dussol ; Bernard Bourbigot ; Nicole Lefranç ; ois ; Elisabeth Cassuto-Viguier ; Olivier Toupance ; Chafik Hacen ; Philippe Lang ; Hakim Mazouz ; Franck Martinez
- 关键词：Anemia ; Kidney-transplant recipient ; Glomerular-filtration rate ; Immunosuppressive treatment ; Erythropoiesis-stimulating agent
- 刊名：Néphrologie Thérapeutique
- 出版年：2008
- 出版时间：December 2008
- 年：2008
- 卷：4
- 期：7
- 页码：575-583
- 全文大小：560 K
Résumé
Les conséquences de l’anémie chez le patient transplanté rénal n’ont pas été bien évaluées. Cela explique certainement la prévalence élevée de l’anémie chez ces patients. L’étude MATRIX, Management of Anemia in French Kidney Transplant Patients, est une étude observationnelle réalisée en France dans dix centres de transplantation ayant pour but d’évaluer la prévalence, les facteurs prédictifs et la prise en charge de l’anémie en transplantation rénale. Sur une période de deux semaines, 418 patients transplantés rénaux (248 hommes, âge moyen : 50,8 ± 12,7 ans) ont été inclus dans cette étude observationnelle multicentrique. Tous étaient transplantés depuis plus de six mois. Chez ces patients, la créatinine plasmatique moyenne était de 152 ± 67 μmol/l et l’hémoglobine de 124 ± 1,8 g/l, significativement plus élevée chez les hommes. Quel que soit le délai suivant la greffe, 23 % des patients (n = 95) étaient sévèrement anémiques (Hb < 110 g/l) et seulement 17 % d’entre eux recevaient un traitement antianémique, 10 % par du fer oral, 7 % par un agent stimulant l’érythropoïèse (ASE) etSummary
The management of anemia after kidney transplantation remains poorly explored. The Management of Anemia in French Kidney Transplant Patients (MATRIX) study is an observational study conducted in 10 academic hospitals among kidney-transplant patients designed to evaluate the prevalence, associated factors and management of post-transplant anemia. Over two consecutive weeks, 418 recipients (males: 248; age: 50.8 ± 12.7 years) were included, all were transplanted for more than six months. Mean serum creatinine (Scr) was 152 ± 67 μmol/l and mean hemoglobin (Hb) was 12.4 ± 1.8 g/dl (males: 12.8 ± 1.9 g/dl; females 11.9 ± 1.6 g/dl). Irrespective of the delay following transplantation, 23 % of patients (n = 95) were severely anemic (Hb ≤ 11 g/dl). Eighteen percent of the patients received an antianemic treatment (10 % oral iron, 7 % erythropoiesis stimulating agents (ESA), 4 % folic acid) and only 35 % of the severely anemic patients were actually treated (n = 33). A significantly-negative correlation was observed between eGFR and Hb levels (R = − 0.347, p < 0.02). Ninety-six percent of the 193 patients transplanted for more than six months and a Scr greater than 150 μmol/l (n = 185) suffered at least one comorbidity (89 % hypertension, 32 % hypercholesterolemia, 13 % diabetes); this group represent the second cohort. Seventy-four percent of them were treated with mycophenolate mofetil, 16 % with azathioprine, and 62 % with an ACEI or angiotensin II receptor antagonists. Since the transplantation, 127 patients (66 % ) have been anemic (Hb ≤ 11 g/dl) and 58 % (n = 112) were treated (iron and/or ESA, respectively 81 and 55 % ). Among the patients not treated for anemia, 74 % had an Hb level below 12 g/dl. ESA-treated patients received a mean dose of 8500 UI ± 2800 per week. Anemia is under-diagnosed and under-treated in renal-transplant recipients, despite its high prevalence. As expected, a correlation between renal function and Hb levels was observed, as in CKD patients. Prospective studies are underway to assess the consequences of postkidney transplant anemia on quality of life, cardiovascular morbidity and chronic allograft nephropathy and to define the benefit of the treatment.