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 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 Johns Hopkins Children's.
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 nor
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Johns Hopkins Medical Institutions