NN&I - June 2010

Clinical Subscribe to our free eNewsletter at www.nephronline.comJune 2010 Nephrology News & Issues 21Anemia tougher to tackle in black American children with kidney diseaseBlack American children with chron -ic kidney disease have more severe anemia than white American children, even when they receive the same treat -ment, according to a multicenter study led by Johns Hopkins Children's Center and published in the May issue of the American Journal of Kidney Disease. The findings suggest that inher -ent biological differences, rather than access to care and treatment, may lead to different outcomes, raising the ques -tion whether current guidelines for anemia treatment should be tailored to reflect race, investigators said. The study involved 429 children ages 1 to 16 with CKD enrolled in 44 study Compiled by Rebecca Zumoffsites across the United States. More than 40% of black children had hemo-globin levels below the fifth percentile for their age and genderdeemed a critical cutoff pointcompared to 29% of white children. Also, fewer black than white children reached higher hemo -globin levels with treatment. The differ -ences persisted even after researchers controlled for factors affecting hemo -globin levels, such as an iron-rich diet and variations in body-mass index. Hemoglobin levels differences among racial groups are nothing new in adults with chronic kidney disease, researchers say, nor are slight varia-tions in hemoglobin between healthy white and black children. The chal -lenge is differentiating between "true" anemia and normal racial variations in hemoglobin levels. "As we move from one-size-fits-all medicine toward individualized medi -cine, we should study further racial disparities and, perhaps, adjust hemo-globin targets to reflect what appear to be genetic variations," said lead investi-gator Meredith Atkinson, MD, MHS, a pediatric nephrologist at Johns Hopkins Children's Hospital.The disease progressed and the ane-mia got worse across the board for all children, and the hemoglobin gap between white and black children wid -ened. As the disease progresses, pediat -ric nephrologists should monitor even more vigilantly hemoglobin levels in their black patients, researchers said. Clinical_NNI0610_5.indd 21 5/14/10 2:53:24 PM