title: Hemoglobin differences by race in children with CKD.
abstract: BACKGROUND
  There are known racial disparities in the prevalence of anemia in adults with chronic kidney disease (CKD), but these differences have not been well described in children.
  
  
  METHODS
  Cohort study, cross-sectional analysis.
  
  
  METHODS
  The Chronic Kidney Disease in Children (CKiD) Study is a multicenter prospective cohort study of children with mild to moderate CKD. This analysis included 429 children of African American or white race.
  
  
  METHODS
  Race.
  
  
  METHODS
  This study examined the association of race with hemoglobin level. Both multiple linear regression and generalized gamma modeling techniques were used to characterize the association between race and hemoglobin level.
  
  
  RESULTS
  79% of the cohort was white, 21% was African American. Neither median hemoglobin level nor frequency of erythropoiesis-stimulating agent use differed by race. In multivariate analysis, lower levels of iohexol-measured glomerular filtration rate, African American race, and glomerular disease (vs nonglomerular disease) as the underlying cause of CKD were independently associated with decreased hemoglobin levels; independent of glomerular filtration rate and CKD diagnosis, African American children had average hemoglobin levels that were 0.6 g/dL (95% CI, -0.9 to -0.2 g/dL) lower than those of white children. Generalized gamma modeling showed that differences in hemoglobin levels observed by race become more pronounced when moving from high to low in the overall hemoglobin level distribution.
  
  
  CONCLUSIONS
  Cross-sectional analysis cannot establish causality, and data for iron stores were not available for all patients.
  
  
  CONCLUSIONS
  African American compared with white children have lower hemoglobin values in CKD independent of the underlying cause of CKD. These racial differences in hemoglobin levels appear to increase at the lower end of the hemoglobin level distribution in this population.
authors.affiliation: Division of Pediatric Nephrology, Johns Hopkins University, Baltimore, MD 21287, USA. matkins3@jhmi.edu
authors.forename: Meredith A
authors.initials: MA
authors.lastname: Atkinson
authors.forename: Christopher B
authors.initials: CB
authors.lastname: Pierce
authors.forename: Rachel M
authors.initials: RM
authors.lastname: Zack
authors.forename: Gina-Marie
authors.initials: GM
authors.lastname: Barletta
authors.forename: Ora
authors.initials: O
authors.lastname: Yadin
authors.forename: Mark
authors.initials: M
authors.lastname: Mentser
authors.forename: Bradley A
authors.initials: BA
authors.lastname: Warady
authors.forename: Susan L
authors.initials: SL
authors.lastname: Furth
mesh_terms: D000293:Adolescent; D001741:Black or African American / Q000208:ethnology*; D000740:Anemia / Q000188:drug therapy / Q000453:epidemiology* / Q000208:ethnology*; D002648:Child; D002908:Chronic Disease; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D019587:Dietary Supplements; D005260:Female; D005919:Glomerular Filtration Rate / Q000502:physiology; D006397:Hematinics / Q000627:therapeutic use; D006454:Hemoglobins / Q000378:metabolism*; D006801:Humans; D007501:Iron / Q000008:administration & dosage / Q000627:therapeutic use; D007674:Kidney Diseases / Q000097:blood* / Q000453:epidemiology / Q000208:ethnology*; D008297:Male; D015999:Multivariate Analysis; D015995:Prevalence; D011446:Prospective Studies; D014481:United States / Q000453:epidemiology; D044465:White People / Q000208:ethnology*
chemical_list: D006397:Hematinics; D006454:Hemoglobins; D007501:Iron