December 5, 2016
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Anemia Tougher To Tackle In Black Children With Kidney Disease



Black children with chronic kidney disease have more severe anemia 
than white children even when they receive the same treatment, 
according to a multicenter study led by the Johns Hopkins Children's 
Center to be published in the May issue of the American Journal of 
Kidney Disease.

The findings suggest that inherent biological differences, rather 
than access to care and treatment, may be at play, raising the 
question whether current guidelines for anemia treatment should be 
tailored to reflect race, investigators say.

Anemia, marked by abnormally low levels of red blood cells, is a key 
indicator of disease status. It is diagnosed by measuring levels of 
the protein hemoglobin, which carries oxygen in and out of red blood 
cells. Hemoglobin levels below 11 grams per deciliter of blood 
generally indicate anemia, but the number is adjusted for a child's 
age and gender.

In the new study, black children with kidney disease had lower 
hemoglobin than white children, 0.6 grams per deciliter on average, 
and a greater proportion of black children were anemic when compared 
with white children. The difference persisted even after researchers 
eliminated certain factors that affect hemoglobin levels, such as 
severity of kidney disease and whether the children received 
treatment with hemoglobin-boosting medications for their anemia.

"As we move from one-size-fits-all medicine toward individualized 
medicine, we should study further racial disparities and, perhaps, 
adjust hemoglobin targets to reflect what appear to be genetic 
variations," said lead investigator Meredith Atkinson, M.D., M.H.S., 
a pediatric nephrologist at the Johns Hopkins Children's Center.

Racial differences in hemoglobin levels are nothing new in adults 
with chronic kidney disease, researchers say, nor are slight 
variations in hemoglobin between healthy white and black children.

The tricky part, researchers say, is differentiating between "true" 
anemia and normal racial variations in hemoglobin levels.

The Johns Hopkins-led study involved 429 children ages 1 to 16 with 
chronic kidney disease enrolled in 44 study sites across the United 
States. More than 40 percent of black children had hemoglobin levels 
below the fifth percentile for their age and gender -- deemed a 
critical cutoff point -- compared to 29 percent of white children. 
Also, fewer African-American than white children reached higher 
hemoglobin levels with treatment. The differences persisted even 
after researchers controlled for factors affecting hemoglobin levels, 
such as an iron-rich diet and body-mass index.

Moreover, researchers found that as the disease progressed and the 
anemia got worse across the board for all children, the hemoglobin 
gap between white and black children widened. This finding suggests 
that as the disease progresses, pediatric nephrologists should 
monitor even more vigilantly hemoglobin levels in their 
African-American patients.

"What we are observing could very well mean that black children's 
hemoglobin levels start to plummet once they reach a certain point in 
their disease," Atkinson said.

Untreated, chronic anemia can speed disease progression and, over 
time, can lead to a dangerous thickening of the heart muscle called 
left-ventricular hypertrophy, among other complications.

Chronic kidney disease affects 26 million people in the United States.

The research was funded by the National Kidney Foundation and the 
Thrasher Research Fund.

Conflict of interest disclosure: Meredith Atkinson received funding 
from Amgen Inc., which manufactures anemia treatment medications, 
among other products. The terms of this arrangement is managed by The 
Johns Hopkins University in accordance with its conflict-of-interest policies.

Co-investigators in the study included Christopher Pierce, 
M.H.S., and Rachel Zack, B.A., of the Johns Hopkins Bloomberg School 
of Public Health; Gina-Marie Barletta, M.D., Helen DeVos Children's 
Hospital in Grand Rapids, Mich.; Ora Yadin, M.D., Mattel Children's 
Hospital at University of California-Los Angeles; Mark Mentser, M.D., 
Ohio State University; Bradley Warady, M.D., Children's Mercy 
Hospital in Kansas City, Mo., and Susan Furth, M.D., Ph.D., 
Children's Hospital of Philadelphia.

 Johns Hopkins Children's Center
Media Contact: Ekaterina Pesheva
epeshev1@jhmi.edu
410-516-4996, 410-926-6780



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