BACKGROUND: Kidney transplant (tx) candidates often receive iron replacement therapies to manage anemia of CKD. At the time of tx, ongoing iron deficiency may delay recovery of anemia post-tx, and patients with post-tx anemia may be at risk for poor graft outcomes and increased mortality. At our center, iron studies are routinely checked at the time of tx. The aim of this study is to describe the incidence of iron deficiency in pre-tx candidates based on the updated KDIGO Guideline from 2012.

METHODS: A retrospective cohort of 257 adult patients who received a kidney tx at our center 4/30/08-9/30/12 was reviewed. Demographic data, iron studes, Hgb/Hct at admission and nadir during inpatient stay, and dialysis modality were collected. Patients were excluded if iron studies were not available or if graft or patient survival was <30 days.

RESULTS: Of the 257 patients, 240 met inclusion criteria (52.1% male, 78.3% Caucasian, mean age 46+/-15.2 yrs). Thymoglobulin induction was used in 85% of patients, and the majority were maintained on a regimen of TAC + MPA +/- corticosteroids. Diabetes was the most common etiology for ESRD, 60.8% received a DD tx, and 80.4% were transplanted for the first time. Pre-tx dialysis modality was primarily via HD (n=151, 62.9%), followed by PD (n=54, 22.5%) and pre-emptive tx (n=35, 14.6%). 239/240 patients were anemic at the time of tx and/or during their post-tx stay, with mean pre-tx and nadir Hgb for women of 11.78+/-1.7 g/dL and 8.34+/-1.2 g/dL and men of 12.10+/1.4 g/dL and 8.77+/-1.4 g/dL, respectively. Mean serum ferritin was 653.7+/-461 ng/mL (range 6-2488 ng/mL) and mean TSAT was 31.8+/-15% (range 6-93%). Per the KDIGO Guideline from 2006, 19.6% of patients were candidates for iron replacement; with the 2012 update, 26.7% of patients are candidates.

CONCLUSION: Under the new KDIGO Guideline, a considerable number of patients, particularly those undergoing pre-emptive kidney tx, are candidates for iron replacement therapy. Post-tx providers should be aware of the need for iron supplementation to assist with recovery of anemia post-tx. Repletion in the pre-tx setting is also encouraged, to minimize the burden of replacement during the initial post-tx stay.

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