Assessment and Evolution of the Hematological Profile in Patients With End-stage Chronic Kidney Disease Undergoing Kidney Transplantation
Year: 2026
Type: article
Study design: Observational Study
Abstract: Introduction End-stage chronic kidney disease (CKD) induces profound changes in the hematopoietic system. Normocytic, normochromic anemia is the most common manifestation, resulting from a deficiency in endogenous erythropoietin (EPO) synthesis, associated with chronic inflammation, uremia, a shortened erythrocyte half-life, and impaired iron metabolism. Kidney transplantation (KT) is the definitive renal replacement therapy, capable of reversing uremia and restoring erythropoiesis. Objectives To evaluate and compare hematological parameters in patients with end-stage chronic kidney disease (CKD) before and after renal transplantation, identifying the rate of anemia resolution and predictive factors for potential hematological complications in the post-graft period. Materials and Methods A prospective, observational, and analytical study was conducted with 50 patients with stage 5 CKD on dialysis who underwent RT between February and September 2019 at Ana Nery Hospital. Clinical and laboratory data were collected pre-transplant and 4-months post-RT. Complete blood counts were analyzed, with data expressed as mean ± standard deviation. Paired Student’s t -tests and Wilcoxon tests were applied, followed by Spearman’s correlation test to confirm the validity of the pairing. Statistical significance was considered when p≤0.05 for a 95% confidence interval. Results: The mean hemoglobin (Hb) level pre-TR was 12.21±2.13“ g/dL” and post-TR was 12.15±2.29“ g/dL” (p>0.05). When stratified by sex, 65.5% of men had anemia (Hb <13 g/dL) pre-TR and 58.6% post-TR. Among women, anemia (Hb <12 g/dL) persisted in 61% of patients both pre- and post-TR. Regarding thromboembolic risk (hemoglobin levels >13 g/dL), 34.5% of men were at risk both before and after TR, while among women the rate rose from 23% to 33%. In the white blood cell count, the mean total white blood cell count decreased from 6,500/mm 3 ± 2,205 before TR to 5,860/mm 3 ± 2,469 after TR (p=0.028). The platelet count rose from 231,000/mm 3 ± 61.1 to 238,000/mm 3 ± 85.9 (p>0.05). Discussion In our study, the mean Hb levels before and after TR were nearly identical, falling within therapeutic target ranges due to the administration of erythropoietin in the end stages of CKD. However, several studies have associated hemoglobin levels above 13 g/dL with higher mortality and a higher prevalence of thrombotic events. In the present study, 34% of men had Hb levels above 13 g/dL both pre- and post-RT, while among women, the percentage with Hb > 13 gt; 13 g/dL rose from 23% to 33% post-RT. Regarding white blood cells, the total white blood cell count was significantly lower after TR, although the values remained within the normal range. These decreased values are possibly associated with the use of immunosuppressants post-RT, as well as the resolution of the inflammatory status and uremic condition due to the efficacy of RT. Conclusion Renal transplantation led to a substantial and sustained improvement in the quality of life and hematological profile of the patients in the study, progressively correcting anemia. However, rigorous hematologic monitoring is essential due to higher postoperative hemoglobin levels in order to stratify and minimize the risk of atherothrombosis in patients, since cardiovascular diseases are the leading cause of death in this population.
Institution: Universidade Federal da Bahia
Language: English
Subfield: Hematology
Field: Medicine
Domain: Health Sciences
Open Access status: diamond
OpenAlex ID: W7223152520