Hemoglobin Decline in Children with Chronic Kidney Disease
Open Access
- 1 March 2008
- journal article
- research article
- Published by Ovid Technologies (Wolters Kluwer Health) in Clinical Journal of the American Society of Nephrology
- Vol. 3 (2), 457-462
- https://doi.org/10.2215/cjn.03020707
Abstract
Background and objectives: The level of glomerular filtration rate at which hemoglobin declines in chronic kidney disease is poorly described in the pediatric population. Design, setting, participants, & measurements: This cross-sectional study of North American children with chronic kidney disease examined the association of glomerular filtration rate, determined by the plasma disappearance of iohexol, and hemoglobin concentration. Results: Of the 340 patients studied, the mean age was 11 ± 4 yr, the mean glomerular filtration rate was 42 ± 14 ml/min per 1.73 m2, and the mean hemoglobin was 12.5 ± 1.5. Below a glomerular filtration rate of 43, the hemoglobin declined by 0.3 g/dl (95% confidence interval −0.2 to −0.5) for every 5-ml/min per 1.73 m2 decrease in glomerular filtration rate. Above a glomerular filtration rate of 43 ml/min per 1.73 m2, the hemoglobin showed a nonsignificant decline of 0.1 g/dl for every 5-ml/min per 1.73 m2 decrease in glomerular filtration rate. Conclusions: In pediatric patients with chronic kidney disease, hemoglobin declines as an iohexol-determined glomerular filtration rate decreases below 43 ml/min per 1.73 m2. Because serum creatinine–based estimated glomerular filtration rates may overestimate measured glomerular filtration rate in this population, clinicians need to be mindful of the potential for hemoglobin decline and anemia even at early stages of chronic kidney disease, as determined by current Schwartz formula estimates. Future longitudinal analyses will further characterize the relationship between glomerular filtration rate and hemoglobin, including elucidation of reasons for the heterogeneity of this association among individuals.Keywords
This publication has 15 references indexed in Scilit:
- Design and Methods of the Chronic Kidney Disease in Children (CKiD) Prospective Cohort StudyClinical Journal of the American Society of Nephrology, 2006
- Prevalence of complications in children with chronic kidney disease according to KDOQIKidney International, 2006
- Glomerular filtration rate via plasma iohexol disappearance: Pilot study for chronic kidney disease in childrenKidney International, 2006
- Executive SummaryAmerican Journal of Kidney Diseases, 2006
- A Practical Guide to Dose-Response Analyses and Risk Assessment in Occupational EpidemiologyEpidemiology, 2004
- In all likelihood: Statistical modelling and inference using likelihood, by Yudi Pawitan. Pp. 528. £40. 2001. ISBN 0 19 850765 8 (Oxford University Press).The Mathematical Gazette, 2002
- Why is erythropoietin made in the kidney? The kidney functions as a critmeterAmerican Journal of Kidney Diseases, 2001
- Relationship between hematocrit and renal function in men and womenKidney International, 2001
- Relation of serum erythropoietin levels to renal excretory function: Evidence for lowered set point for erythropoietin production in chronic renal failureThe Journal of Pediatrics, 1988
- A simple estimate of glomerular filtration rate in adolescent boysThe Journal of Pediatrics, 1985