Anemia Is a Predictor of Outcome in Heart Transplant Recipients

BackgroundCardiovascular disease and kidney disease share similar characteristics. It has been recently recognized that many patients with cardiovascular disease have anemia, which often is associated with kidney dysfunction. Even the term “cardiorenal anemia syndrome” was endorsed to stress the dangerous association.ObjectiveTo assess the prevalence of anemia in relation to chronic kidney disease in 160 patients after orthotopic heart transplantation.ResultsAccording to the World Health Organization definition of anemia (hemoglobin concentration <13 g/dL in males and <12 g/dL in females), 41% of our patients had anemia. Patients with anemia exhibited a significantly lower mean (SD) glomerular filtration rate (GFR) using the Modification of Diet in Renal Disease formula vs the Cockcroft-Gault formula: 44.46 (26.84) mL/min vs 62.70 (24.15) mL/min and 48.93 (27.80) mL/min vs 72.11 (29.76) mL/min, respectively (P < .001). In addition, they demonstrated lower creatinine clearance, red blood cell count, hemoglobin concentration, and ejection fraction and significantly higher creatinine and N-terminal probrain natriuretic peptide concentrations. Presence of anemia was associated with time since transplantation, GFR, creatinine clearance, N-terminal probrain natriuretic peptide and cholesterol concentrations, and ejection fraction. At multiple regression analysis, the only predictor of anemia was kidney function (GFR or creatinine clearance), which accounts for 22% of the variation. Type of immunosuppression regimen (calcineurin inhibitors vs mammalian target of rapamycin) did not seem to affect prevalence of anemia in the study population.ConclusionsThe prevalence of anemia is relatively high in heart allograft recipients and is not adequately treated. In patients with cardiovascular disease, GFR should be estimated because renal dysfunction and subsequent anemia are important risk factors for cardiovascular morbidity and mortality. Chronic heart failure is also more common in patients with anemia.