The finding that one in five patients maintained an Hb concentration in the range 11-12g/dL at months 7, 8, and 9 was consistent with the results of observational studies of C.E.R.A. therapy in patients receiving hemodialysis [37] or peritoneal dialysis [38]. These have reported Hb levels within selleck screening library the 11-12g/dL window at all three evaluation visits in 15.6% and 18.4% of patients, respectively. These findings should be interpreted against the background of a naturally high degree of Hb variability in patients with CKD [39, 40]. Indeed, it has been shown that the mean within-patient variability is greater than 1g/dL in CKD patients receiving ESA therapy [40, 41].

Comparisons of Hb stability between the current results and randomized trials of ESA therapies are not clinically relevant since this observational study applied no exclusion criteria for Hb cycling prior to inclusion, in contrast to controlled trials which have typically excluded patients with Hb fluctuation > 1g/dL during screening [34, 42�C44]. One previous study, AnemiaTrans, has examined the use of C.E.R.A. in kidney transplant recipients [45]. AnemiaTrans was a retrospective, multicenter study which included both de novo patients (n = 32) and maintenance patients (n = 286). As in the current study, the majority of maintenance patients were converted from another ESA therapy to C.E.R.A. Hb levels were monitored for six months from the time of conversion, and consistent with our results, the proportion of patients within the target Hb range of 11�C13g/dL was similar at baseline and at month 6.

In the majority of converted patients (52.5%), Hb level fluctuated by less than 1g/dL between baseline and month 6. The mean C.E.R.A. dose at month 6 (93��g) was remarkably similar to that used in our population (95.1��g). The findings of AnemiaTrans, although retrospective, support those of the present study. The Kidney Disease: Improving Global Outcomes (KDIGO) guidelines for the care of kidney transplant recipients recommend that anemia in kidney transplant patients should be monitored and treated in the same way as patients with CKD [46]. Regular monitoring of Hb levels is mandatory for all recipients [46], but certain subpopulations are at particular risk of anemia.

As in the nontransplant population, poor renal function is the strongest predictor [1, 4, 6], but low iron stores [1, 4, 6], probably female gender [4, 6, 47], increasing recipient age [4, 6, 33], donor age [1], poor nutrition, and chronic inflammation [48] also appear to contribute, exacerbated by frequent use of renin-angiotensin-aldosterone Drug_discovery system inhibitors [3, 46]. The risk of anemia following transplantation is compounded by immunosuppression with mTOR inhibitors [46, 49�C51] or mycophenolic acid [46, 52, 53], although this effect is less marked in the presence of higher GFR [54].