Racial Disparities in Black and White Children with Chronic Kidney Disease

Despite receiving the same treatment, black children with chronic kidney disease suffer from more severe anemia than white children, according to a new study from Johns Hopkins Children’s Center.

Study leader Meredith Atkinson, MD, MHS, pediatric nephrologists, Johns Hopkins Children’s, and colleagues found that 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.” This difference continued to be present even after the researchers eliminated factors that affect hemoglobin levels, such as severity of kidney disease and whether the children were given hemoglobin-boosting medications. In addition, as kidney disease progressed and the children’s anemia worsened, the gap in hemoglobin levels widened.

“What we are observing could very well mean that black children’s hemoglobin levels start to plummet once they reach a certain point in their disease,” said Atkinson, lead author of the study published in the American Journal of Kidney Diseases.

The present study involved 429 children, age 1-16 years, who were suffering from chronic kidney disease and enrolled in 44 study sites across the US. According to the researchers, “more than 40% of black children had hemoglobin levels below the fifth percentile for their age and gender—deemed a critical cutoff point—compared to 29 percent of white children.”

Previous research has shown that racial differences exist between hemoglobin levels in adults with chronic kidney disease, and that there are differences in hemoglobin levels between healthy black and white children. According to Atkinson, the results of this new study may suggest that pediatric nephrologists need to be more vigilant about monitoring hemoglobin levels in their African-American patients.

“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 Atkinson.