IRON DEFICIENCY: AN UNDER-RECOGNIZED PROBLEM IN KIDNEY TRANSPLANTATION. RISKS OF IRON TREATMENT.

P297 Aims: There are many studies about metabolism and iron requirements of dialysis patients. The prevalence of iron deficiency is well established during the early weeks after transplantation.However, only a few studies have been made about the state of iron deposits in long term kidney graft recipients. Angiotensin converting enzyme inhibitors (ACEIs) reduce the hematocrit (Ht) level in patients with posttransplant erythrocytosis (PTE), but their action mechanism and the way they modify iron deposits have not been studied. Furthermore, iron treatment safety in iron deficient patients without anemia has been insufficiently evaluated. This study was prospectively designed to evaluate 1.- Prevalence of iron deficiency in transplanted patients without anemia. 2.- Efficacy of ACEI treatment on erythrocytosis patients and its influence on iron deposits. 3.- Risks of iron treatment in patients with symptomatic iron deficiency but no anemia. Methods: All patients with a graft kidney for more than a year were studied. Inclusion criteria were: creatinine (Cr) serum levels < 2 mg/dl, no anemia and neither iron, rHuEpo, ACEI nor ARA treatment. They were divided in two groups: normal Ht (group 1) and PTE (defined by Ht>51%) (group 2). Iron deficiency was defined by a transferrin saturation index (TSI) < 20% and/or a serum ferritin level < 40 mg/dl. Symptoms due to iron deficiency (hair loss, glossitis, cheilitis or asthenia) and their response and secondary effects to oral iron treatment (525 mg/day of ferrum sulphate until resolution of symptoms) were evaluated. 20 normal Ht (controls) and 21 PTE patients (group PTE) were treated with enalapril (2.5-5 mg/day). Ferritin, TSI and Ht levels were determined before and 15, 30, 90, 180 and 365 days after enalapril treatment. Differences between means were analyzed using a Student`s test for two independent samples. Results: 138 patients were included in this study, 117 (84.7%) had normal Ht (group 1) and 21 (15.21%) PTE (group 2). Iron deficiency was found in 73 (62.4%) patients in group 1 and in 10 (47%) patients in group 2. Two patients of group 1 had symptoms of iron deficiency (one of them glossitis and asthenia and the other important hair loss). Both were treated with iron. Symptoms disappeared, but one of them developed PTE, (the Ht increased from 42 to 59%). Enalapril treatment significantly decreased Ht levels in PTE patients (p<0.025) but not in controls. On the other hand, this drug increased TSI and ferritin levels in PTE patients and TSI in controls with iron deficiency (p<0.05). However, TSI and ferritin levels remained unchanged after enalapril treatment in PTE and controls without iron deficiency. Conclusions: High prevalence of iron deficiency in long-term renal transplant recipients without anemia. Iron treatment in kidney transplant recipients must be carefully used because of the risk of erythrocytosis. Enalapril treatment decreases Ht levels in PTE patients but not in controls. Enalapril treatment increases TSI and ferritin levels only in patients with iron deficiency.

Topic: Hemoglobinopathies and Related Disorders
Subfield: Genetics
Field: Medicine
Domain: Health Sciences