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Kidney Week

Abstract: PO2502

Anemia and Decreased Muscle Mass and Muscle Strength in Kidney Transplant Recipients

Session Information

Category: Transplantation

  • 1902 Transplantation: Clinical

Authors

  • Vinke, Joanna Sophia Jacoline, University Medical Center Groningen, Department of Nephrology, Groningen, Netherlands
  • Wouters, Hanneke J.C.M., University Medical Center Groningen, Department of Hematology, Groningen, Netherlands
  • Post, Adrian, University Medical Center Groningen, Department of Nephrology, Groningen, Netherlands
  • Stam, Suzanne P., University Medical Center Groningen, Department of Nephrology, Groningen, Netherlands
  • Douwes, Rianne M., University Medical Center Groningen, Department of Nephrology, Groningen, Netherlands
  • Gomes Neto, Antonio Wouter, University Medical Center Groningen, Department of Nephrology, Groningen, Netherlands
  • Berger, Stefan P., University Medical Center Groningen, Department of Nephrology, Groningen, Netherlands
  • Bakker, Stephan J.L., University Medical Center Groningen, Department of Nephrology, Groningen, Netherlands
  • De Borst, Martin H., University Medical Center Groningen, Department of Nephrology, Groningen, Netherlands
  • Eisenga, Michele F., University Medical Center Groningen, Department of Nephrology, Groningen, Netherlands
Background

Anemia is highly prevalent in kidney transplant recipients (KTRs). It is known that anemia impairs quality of life, especially physical functioning. Although surmised, data about the latter in KTRs specifically are scarce. Hence, we aimed to investigate the association between anemia and muscle mass and muscle strength in KTRs.

Methods

In a prospective study among KTRs participating in the TransplantLines Biobank and Cohort study, we used KTRs >1 yr post-transplant with data on hemoglobin (Hb) levels and muscle mass. Muscle mass was assessed in two ways: by using 24-hour urinary creatinine excretion and with bioelectrical impedance analysis (BIA). Muscle strength was determined by means of hand grip strength using a dynamometer. The mean overall hand grip strength was calculated out of three attempts of both hands with 30 seconds recovery time in between.
Anemia was defined as Hb <12 g/dL for women and <13 g/dL for men, according to WHO definitions. We used multivariable linear regression analyses to assess associations between anemia and muscle mass and strength.

Results

We included 824 KTRs (age 56±13 years, 60% males, eGFR 52±18 mL/min/1.73 m2, serum Hb 13.5±1.8 g/dL). Anemia was present in 30% of KTRs. Hb levels were associated with creatinine excretion, independent of age, sex, eGFR, BMI, hs-CRP, smoking status, alcohol use and the use of RAAS-inhibitors, statins, calcineurin inhibitors, proliferation inhibitors or prednisolone (st.β=0.14, P=0.001). Similarly, the presence of anemia was independently associated with a lower creatinine excretion (st. β=-0.09, P=0.021). Hb levels (st.β=0.20, P<0.001) were also independently associated with muscle mass, estimated using BIA resistance measurements. In line with muscle mass parameters, Hb (st.β=0.18, P<0.001) and anemia (st.β=-0.11, P=0.005) were associated with handgrip strength independent of potential confounders as well.

Conclusion

Low hemoglobin levels and anemia are both strongly associated with lower muscle mass and muscle strength in KTRs, likely impairing physical functioning. Future research is needed to address whether correction of anemia improves physical performance in KTRs.