TY - JOUR
T1 - Regional Variation in Hemoglobin Distribution Among Individuals With CKD
T2 - the ISN International Network of CKD Cohorts
AU - ISN iNET-CKD Investigators
AU - Canney, Mark
AU - Induruwage, Dilshani
AU - Tang, Mila
AU - Alencar de Pinho, Natalia
AU - Er, Lee
AU - Zhao, Yinshan
AU - Djurdjev, Ognjenka
AU - Ahn, Yo Han
AU - Behnisch, Rouven
AU - Calice-Silva, Viviane
AU - Chesnaye, Nicholas C.
AU - de Borst, Martin H.
AU - Dember, Laura M.
AU - Dionne, Janis
AU - Ebert, Natalie
AU - Eder, Susanne
AU - Fenton, Anthony
AU - Fukagawa, Masafumi
AU - Furth, Susan L.
AU - Hoy, Wendy E.
AU - Imaizumi, Takahiro
AU - Jager, Kitty J.
AU - Jha, Vivekanand
AU - Kang, Hee Gyung
AU - Kitiyakara, Chagriya
AU - Mayer, Gert
AU - Oh, Kook Hwan
AU - Onu, Ugochi
AU - Pecoits-Filho, Roberto
AU - Reichel, Helmut
AU - Richards, Anna
AU - Schaefer, Franz
AU - Schaeffner, Elke
AU - Scheppach, Johannes B.
AU - Sola, Laura
AU - Ulasi, Ifeoma
AU - Wang, Jinwei
AU - Yadav, Ashok K.
AU - Zhang, Jianzhen
AU - Feldman, Harold I.
AU - Taal, Maarten W.
AU - Stengel, Bénédicte
AU - Levin, Adeera
AU - Ahn, Curie
AU - Berger, Stefan P.
AU - Caskey, Fergus J.
AU - Cho, Min Hyun
AU - Cho, Heeyeon
AU - Heerspink, Hiddo Lambers
AU - de Zeeuw, Dick
N1 - Funding Information:
The authors thank all participants of the iNET-CKD cohort studies without whom this work would not be possible. This work was supported by an unrestricted grant from GSK, in-kind administrative support from the ISN, and in-kind analytical support from BC Renal.
Publisher Copyright:
© 2023
PY - 2023/10
Y1 - 2023/10
N2 - 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.
AB - 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.
KW - anemia
KW - chronic kidney disease
KW - geography
KW - glomerular filtration rate
KW - hemoglobin
KW - sex
UR - http://www.scopus.com/inward/record.url?scp=85172452024&partnerID=8YFLogxK
U2 - 10.1016/j.ekir.2023.07.032
DO - 10.1016/j.ekir.2023.07.032
M3 - Article
AN - SCOPUS:85172452024
SN - 2468-0249
VL - 8
SP - 2056
EP - 2067
JO - Kidney International Reports
JF - Kidney International Reports
IS - 10
ER -