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In Children With CKD, Race Linked to Hemoglobin Levels

In chronic kidney disease, African-American children have lower levels than white children

WEDNESDAY, April 28 (HealthDay News) -- African-American children with chronic kidney disease (CKD) have lower hemoglobin levels than white children with the disease, regardless of the disease's underlying cause, according to a study published online April 26 in the American Journal of Kidney Diseases.

Meredith A. Atkinson, M.D., of Johns Hopkins University in Baltimore, and colleagues conducted a cross-sectional cohort study of 429 children of African-American or white race as part of the multi-center CKD in Children study. They examined the association between race and hemoglobin level in the population, which was 79 percent white and 21 percent African-American.

The researchers found that median hemoglobin levels did not differ by race, nor did frequency of use of erythropoiesis-stimulating agents. In multivariate analysis, several factors were independently associated with lower hemoglobin levels, including African-American race, glomerular (versus nonglomerular) disease as the cause of the CKD, and lower levels of iohexol-measured glomerular filtration rate. Independent of CKD diagnosis and glomerular filtration rate, African-American race was associated with an average hemoglobin level that was 0.6 g/dL lower than that of white race. Racial differences were more marked at the lower end of the hemoglobin level distribution.

"Although African-American children as a group have lower hemoglobin levels than white children, the greatest racial disparity occurs in children who are the sickest (i.e., those with the lowest hemoglobin levels). Although our linear regression analysis did not show a quantitative difference by race in the hemoglobin-measured glomerular filtration rate relationship, we can speculate that specific factors promoting anemia in children with progressive CKD, including erythropoietin deficiency, inflammation, and hyperparathyroidism, may have differential effects in children of different races," the authors write.

Atkinson was supported by grant funding from Amgen Inc.

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