Related Experiment Video
Updated: Jun 13, 2026
Characterization of Sickling During Controlled Automated Deoxygenation with Oxygen Gradient Ektacytometry
Published on: November 5, 2019
Hemoglobin differences by race in children with CKD
Meredith A Atkinson1, Christopher B Pierce, Rachel M Zack
1Division of Pediatric Nephrology, Johns Hopkins University, Baltimore, MD 21287, USA. matkins3@jhmi.edu
Insights
Racial disparities in hemoglobin levels exist in children with chronic kidney disease (CKD). African American children with CKD had lower hemoglobin levels than white children, independent of CKD cause.
Area of Science:
- Pediatric Nephrology
- Hematology
- Public Health
Background:
- Racial disparities in anemia are documented in adult chronic kidney disease (CKD).
- These disparities are less understood in pediatric populations with CKD.
Purpose of the Study:
- To investigate racial differences in hemoglobin levels among children with CKD.
- To determine if race is an independent predictor of hemoglobin levels in pediatric CKD.
Main Methods:
- A cross-sectional analysis of 429 children from the Chronic Kidney Disease in Children (CKiD) Study.
- Examined the association between race (African American vs. white) and hemoglobin levels using multiple linear regression and generalized gamma modeling.
Main Results:
- African American children constituted 21% of the cohort.
- African American children had lower average hemoglobin levels (0.6 g/dL lower) than white children, independent of glomerular filtration rate and CKD diagnosis.
- Hemoglobin level differences by race were more pronounced at lower hemoglobin concentrations.
Conclusions:
- African American children with CKD exhibit lower hemoglobin levels compared to white children, irrespective of CKD etiology.
- These racial disparities in hemoglobin are more evident at the lower end of the hemoglobin distribution in pediatric CKD.
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.
Study Design:
Cohort study, cross-sectional analysis.
Setting & Participants:
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.
Predictor:
Race.
Outcomes & Measurements:
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.
Limitations:
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.
Related Concept Videos
01:24Chronic Kidney Disease II: Clinical Manifestations
01:49Multiple Allele Traits
01:27Disorders of Erythrocytes
Erythrocyte disorders can be broadly categorized into two main types: anemic and polycythemic conditions.
A low oxygen-carrying capacity of the blood due to the loss, lower production, or destruction of erythrocytes is termed anemia. Hemorrhagic anemia, for example, occurs when bleeding from an external wound or internal ulcer reduces erythrocyte counts.
On the other...
01:28Drug Dosing in Renal Diseases: Estimation of Glomerular Filtration Rate Based on Serum Creatinine Concentration
01:24Hemoglobin
When all four heme groups are bound to oxygen, the resulting molecule is called oxyhemoglobin. As a result, arterial blood...
01:24Pharmacokinetics in Pediatric Patients: Drug Metabolism