Regional Variation in Hemoglobin Distribution Among Individuals With CKD: the ISN International Network of CKD Cohorts.

Canney M, Induruwage D, Tang M, Alencar de Pinho N, Er L, Zhao Y, Djurdjev O, Ahn YH, Behnisch R, Calice-Silva V, Chesnaye NC, de Borst MH, Dember LM, Dionne J, Ebert N, Eder S, Fenton A, Fukagawa M, Furth SL, Hoy WE, Imaizumi T, Jager KJ, Jha V, Kang HG, Kitiyakara C, Mayer G, Oh KH, Onu U, Pecoits-Filho R, Reichel H, Richards A, Schaefer F, Schaeffner E, Scheppach JB, Sola L, Ulasi I, Wang J, Yadav AK, Zhang J, Feldman HI, Taal MW, Stengel B, Levin A, Ahn C, Berger SP, Caskey FJ, Cho MH, Cho H, Dekker FW, Diwan V, Drechsler C, Eckardt KU, Evans M, Ferreiro A, Floege J, Gadola L, Haller H, Han KH, Healy HG, Heerspink HL, Hemmelder M, Hiemstra T, Hilbrands L, Kim SH, Klyprayong P, Köttgen A, Kronenberg F, Lamadrid V, Lee JH, Mark P, Matheson M, Mi E, Noppakun K, Oefner P, Panaput T, Park YS, Prokosch HU, Reis A, Rios P, Rosivall L, Rotmans JI, Sackeyfio A, Sangthawan P, Schmid M, Shin JI, Silavarino R, Sitter T, Sommerer C, Szymczak M, Torino C, Toth J, van Ittersum FJ, Venuthurupalli SK, Verhaar MC, Wang Z, Wanner C, Wiecek A, Wolf G, de Zeeuw D, Zhang L, Zheng Y, Zhao MH, Zietse R (2023)

Publication Type: Journal article

Publication year: 2023

Journal

Book Volume: 8

Pages Range: 2056-2067

Journal Issue: 10

DOI: 10.1016/j.ekir.2023.07.032

Abstract

INTRODUCTION: Despite recognized geographic and sex-based differences in hemoglobin in the general population, these factors are typically ignored in patients with chronic kidney disease (CKD) in whom a single therapeutic range for hemoglobin is recommended. We sought to compare the distribution of hemoglobin across international nondialysis CKD populations and evaluate predictors of hemoglobin. METHODS: In this cross-sectional study, hemoglobin distribution was evaluated in each cohort overall and stratified by sex and estimated glomerular filtration rate (eGFR). Relationships between candidate predictors and hemoglobin were assessed from linear regression models in each cohort. Estimates were subsequently pooled in a random effects model. RESULTS: A total of 58,613 participants from 21 adult cohorts (median eGFR range of 17-49 ml/min) and 3 pediatric cohorts (median eGFR range of 26-45 ml/min) were included with broad geographic representation. Hemoglobin values varied substantially among the cohorts, overall and within eGFR categories, with particularly low mean hemoglobin observed in women from Asian and African cohorts. Across the eGFR range, women had a lower hemoglobin compared to men, even at an eGFR of 15 ml/min (mean difference 5.3 g/l, 95% confidence interval [CI] 3.7-6.9). Lower eGFR, female sex, older age, lower body mass index, and diabetic kidney disease were all independent predictors of a lower hemoglobin value; however, this only explained a minority of variance (R2 7%-44% across cohorts). CONCLUSION: There are substantial regional differences in hemoglobin distribution among individuals with CKD, and the majority of variance is unexplained by demographics, eGFR, or comorbidities. These findings call for a renewed interest in improving our understanding of hemoglobin determinants in specific CKD populations.

Involved external institutions

BC Renal Agency Canada (CA) Seoul National University (SNU) / 서울대학교 Korea, Republic of (KR) Universitätsklinikum Heidelberg Germany (DE) Pró-Rim Foundation / Fundação Pró-Rim Brazil (BR) University of Amsterdam Netherlands (NL) University Medical Center Groningen (UMCG) / Universitair Medisch Centrum Groningen Netherlands (NL) University of Pennsylvania (UPenn) United States (USA) (US) University of British Columbia Canada (CA) Charité - Universitätsmedizin Berlin Germany (DE) Medizinische Universität Innsbruck Austria (AT) University of Birmingham United Kingdom (GB) Tokai University / 東海大学 (Tōkai Daigaku) Japan (JP) University of Nottingham United Kingdom (GB) Research Center in Epidemiology and Population Health / Centre de recherche en Epidémiologie et Santé des Populations (CESP) France (FR) University of Mississippi Medical Center United States (USA) (US) Nagoya University / 名古屋大学 Japan (JP) The George Institute for Global Health Australia (AU) Ramathibodi Hospital / โรงพยาบาลรามาธิบดี Thailand (TH) Arbor Research Collaborative for Health United States (USA) (US) GlaxoSmithKline plc. (GSK) United Kingdom (GB) Postgraduate Institute of Medical Education and Research (PGIMER) / स्नातकोत्तर चिकित्सा शिक्षा एवं अनुसंधान संस्थान चण्डीगढ़ India (IN) University of Ottawa Canada (CA) University of Nigeria Nigeria (NG) Peking University First Hospital / 北大国际医院 China (CN)

How to cite

APA:

Canney, M., Induruwage, D., Tang, M., Alencar de Pinho, N., Er, L., Zhao, Y.,... Zietse, R. (2023). Regional Variation in Hemoglobin Distribution Among Individuals With CKD: the ISN International Network of CKD Cohorts. Kidney International Reports, 8(10), 2056-2067. https://doi.org/10.1016/j.ekir.2023.07.032

MLA:

Canney, Mark, et al. "Regional Variation in Hemoglobin Distribution Among Individuals With CKD: the ISN International Network of CKD Cohorts." Kidney International Reports 8.10 (2023): 2056-2067.

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