Treatment options for anemia in kidney transplant patients: a review

Anemia is common after kidney transplantation. The etiology may be multifactorial including both causes of anemia in the general population and more specific causes unique to the kidney transplant setting. Post-transplant anemia, particularly when severe, may be associated with adverse effects including graft failure, mortality, and a decline in kidney function. After careful investigation, having excluded or treated reversible causes of anemia, treatment of anemia in patients with a kidney transplant is based on iron supplementation and/or erythropoiesis stimulating agents though there are no specific guidelines on anemia management in this patient population. Iron therapy is often needed, but optimal and safe iron deficiency management strategies remain to be defined. Evidence suggests that erythropoiesis stimulating agents are safe and potentially associated with favorable outcomes. Better graft function has been reported upon ESA use targeting hemoglobin levels higher than those recommended in the general chronic kidney disease population with no apparent increased risk of cardiovascular events. These results require further investigation. Data on the use of hypoxia-inducible factor inhibitors are limited. Prevention and treatment of anemia in kidney transplantation can improve patients’ quality of life, life expectancy, allograft function, and survival.