Burden of anemia in kidney transplant patients: Epidemiology, pathophysiology, and management

Abstract

Anemia following kidney transplantation (KTx) is a prevalent complication that adversely affects allograft function, graft survival, and patient survival. Its etiology is multifactorial, encompassing general causes of anemia and KTx-specific factors, such as immunosuppression and reduced erythropoietin production. Management primarily involves iron supplementation and erythropoiesis-stimulating agents (ESAs); however, specific guidelines for post-KTx anemia are lacking, and the optimal methods for treating iron deficiency in KTx recipients remain undefined. Emerging evidence suggests that sodium-glucose cotransporter-2 inhibitors may improve hemoglobin and hematocrit levels in patients with chronic kidney disease and KTx recipients.

To review recent advances in the pathogenesis, epidemiology, treatment, and outcomes of post-KTx anemia, we conducted a literature search using PubMed, Google Scholar, and Google, with keywords including "anemia in kidney transplantation," "anemia etiology in KTx recipients," "iron deficiency in renal transplantation," and "short- and long-term effects of anemia in KTx recipients."

This review synthesizes evidence indicating that effective management of post-KTx anemia, through ESAs and supplementation of erythropoiesis essentials (iron, folate, vitamin B12), is safe and may confer renoprotective benefits. Targeted anemia correction enhances quality of life, reduces mortality, improves transplanted kidney function, and lowers the risk of graft rejection, underscoring the need for standardized treatment protocols.