Anemia has a negative impact on self-rated health in kidney transplant recipients with well-functioning grafts: findings from an 8-year follow-up study

Anemia is a predictor of mortality and of self-rated health (SRH). However, studies on the relationship between SRH and changes in hemoglobin (Hb) value over time stratified by chronic kidney disease (CKD) stages are lacking. The aim is to explore whether a change in Hb-value over time associates with SRH at up to 8-year follow-up, stratified for CKD stages. A prospective study with a baseline measurement between the 3rd and 12th month after KT was performed on 337 consecutive patients. Demographic and clinical data were retrieved from medical records. CKD stages were estimated using the CKD-EPI formula and divided into two groups: CKD1-2 and CKD3-5. Generalized estimating equations (GEE) were performed to identify associations of SRH at follow-up in both CKD groups. Male gender, new-onset diabetes mellitus after KT (NODAT), a decrease in estimated glomerular filtration rate (eGFR) and Hb-value over time contributed significantly to the GEE model on SRH at follow-up in CKD1-2. For SRH at follow-up in CKD3-5, older age, male gender and chronic renal allograft dysfunction (CRAD) contributed significantly to the GEE model. At up to 8-year follow-up, male gender, NODAT, a decrease in eGFR and Hb-value over time are associated with poorer SRH in CKD1-2. In such patients, we suggest monitoring slight deteriorations in eGFR and Hb-values. In CKD3-5, higher age, male gender and higher presence of CRAD are associated with poorer SRH at up to 8-year follow-up. In these patients, adequate treatment would slow down CRAD progression.