Regional Variation in Hemoglobin Distribution Among Individuals With CKD: the ISN International Network of CKD Cohorts
Issued Date
2023-01-01
Resource Type
ISSN
24680249
Scopus ID
2-s2.0-85172452024
Journal Title
Kidney International Reports
Rights Holder(s)
SCOPUS
Bibliographic Citation
Kidney International Reports (2023)
Suggested Citation
Canney M., Induruwage D., Tang M., Alencar de Pinho N., Er L., Zhao Y., Djurdjev O., Ahn Y.H., Behnisch R., Calice-Silva V., Chesnaye N.C., de Borst M.H., Dember L.M., Dionne J., Ebert N., Eder S., Fenton A., Fukagawa M., Furth S.L., Hoy W.E., Imaizumi T., Jager K.J., Jha V., Kang H.G., Kitiyakara C., Mayer G., Oh K.H., Onu U., Pecoits-Filho R., Reichel H., Richards A., Schaefer F., Schaeffner E., Scheppach J.B., Sola L., Ulasi I., Wang J., Yadav A.K., Zhang J., Feldman H.I., Taal M.W., Stengel B., Levin A., Ahn C., Berger S.P., Caskey F.J., Cho M.H., Cho H., Dekker F.W., Diwan V., Drechsler C., Eckardt K.U., Evans M., Ferreiro A., Floege J., Gadola L., Haller H., Han K.H., Healy H.G., Heerspink H.L., Hemmelder M., Hiemstra T., Hilbrands L., Kim S.H., Klyprayong P., Köttgen A., Kronenberg F., Lamadrid V., Lee J.H., Mark P., Matheson M., Mi E., Noppakun K., Oefner P., Panaput T., Park Y.S., Prokosch H.U., Reis A., Rios P., Rosivall L., Rotmans J.I., Sackeyfio A., Sangthawan P., Schmid M., Shin J.I., Silavarino R., Sitter T., Sommerer C., Szymczak M., Torino C., Toth J., van Ittersum F.J., Venuthurupalli S.K., Verhaar M.C., Wang Z., Wanner C., Wiecek A., Wolf G., de Zeeuw D., Zhang L. Regional Variation in Hemoglobin Distribution Among Individuals With CKD: the ISN International Network of CKD Cohorts. Kidney International Reports (2023). doi:10.1016/j.ekir.2023.07.032 Retrieved from: https://repository.li.mahidol.ac.th/handle/20.500.14594/90335
Title
Regional Variation in Hemoglobin Distribution Among Individuals With CKD: the ISN International Network of CKD Cohorts
Author(s)
Canney M.
Induruwage D.
Tang M.
Alencar de Pinho N.
Er L.
Zhao Y.
Djurdjev O.
Ahn Y.H.
Behnisch R.
Calice-Silva V.
Chesnaye N.C.
de Borst M.H.
Dember L.M.
Dionne J.
Ebert N.
Eder S.
Fenton A.
Fukagawa M.
Furth S.L.
Hoy W.E.
Imaizumi T.
Jager K.J.
Jha V.
Kang H.G.
Kitiyakara C.
Mayer G.
Oh K.H.
Onu U.
Pecoits-Filho R.
Reichel H.
Richards A.
Schaefer F.
Schaeffner E.
Scheppach J.B.
Sola L.
Ulasi I.
Wang J.
Yadav A.K.
Zhang J.
Feldman H.I.
Taal M.W.
Stengel B.
Levin A.
Ahn C.
Berger S.P.
Caskey F.J.
Cho M.H.
Cho H.
Dekker F.W.
Diwan V.
Drechsler C.
Eckardt K.U.
Evans M.
Ferreiro A.
Floege J.
Gadola L.
Haller H.
Han K.H.
Healy H.G.
Heerspink H.L.
Hemmelder M.
Hiemstra T.
Hilbrands L.
Kim S.H.
Klyprayong P.
Köttgen A.
Kronenberg F.
Lamadrid V.
Lee J.H.
Mark P.
Matheson M.
Mi E.
Noppakun K.
Oefner P.
Panaput T.
Park Y.S.
Prokosch H.U.
Reis A.
Rios P.
Rosivall L.
Rotmans J.I.
Sackeyfio A.
Sangthawan P.
Schmid M.
Shin J.I.
Silavarino R.
Sitter T.
Sommerer C.
Szymczak M.
Torino C.
Toth J.
van Ittersum F.J.
Venuthurupalli S.K.
Verhaar M.C.
Wang Z.
Wanner C.
Wiecek A.
Wolf G.
de Zeeuw D.
Zhang L.
Induruwage D.
Tang M.
Alencar de Pinho N.
Er L.
Zhao Y.
Djurdjev O.
Ahn Y.H.
Behnisch R.
Calice-Silva V.
Chesnaye N.C.
de Borst M.H.
Dember L.M.
Dionne J.
Ebert N.
Eder S.
Fenton A.
Fukagawa M.
Furth S.L.
Hoy W.E.
Imaizumi T.
Jager K.J.
Jha V.
Kang H.G.
Kitiyakara C.
Mayer G.
Oh K.H.
Onu U.
Pecoits-Filho R.
Reichel H.
Richards A.
Schaefer F.
Schaeffner E.
Scheppach J.B.
Sola L.
Ulasi I.
Wang J.
Yadav A.K.
Zhang J.
Feldman H.I.
Taal M.W.
Stengel B.
Levin A.
Ahn C.
Berger S.P.
Caskey F.J.
Cho M.H.
Cho H.
Dekker F.W.
Diwan V.
Drechsler C.
Eckardt K.U.
Evans M.
Ferreiro A.
Floege J.
Gadola L.
Haller H.
Han K.H.
Healy H.G.
Heerspink H.L.
Hemmelder M.
Hiemstra T.
Hilbrands L.
Kim S.H.
Klyprayong P.
Köttgen A.
Kronenberg F.
Lamadrid V.
Lee J.H.
Mark P.
Matheson M.
Mi E.
Noppakun K.
Oefner P.
Panaput T.
Park Y.S.
Prokosch H.U.
Reis A.
Rios P.
Rosivall L.
Rotmans J.I.
Sackeyfio A.
Sangthawan P.
Schmid M.
Shin J.I.
Silavarino R.
Sitter T.
Sommerer C.
Szymczak M.
Torino C.
Toth J.
van Ittersum F.J.
Venuthurupalli S.K.
Verhaar M.C.
Wang Z.
Wanner C.
Wiecek A.
Wolf G.
de Zeeuw D.
Zhang L.
Author's Affiliation
Prasanna School of Public Health
Faculty of Medicine
Nagoya University Graduate School of Medicine
Arbor Research Collaborative for Health
Peking University First Hospital
Amsterdam Public Health
Centre de Recherche en Épidémiologie et Santé des Populations
George Institute for Global Health
University of Nottingham Medical School
The University of Queensland
Tokai University School of Medicine
Charité – Universitätsmedizin Berlin
University of Nigeria
GlaxoSmithKline plc.
Imperial College Faculty of Medicine
Pontifícia Universidade Católica do Paraná
University of Birmingham
Monash University
Universidade da Regiao de Joinville
Faculty of Medicine Ramathibodi Hospital, Mahidol University
Seoul National University
The University of British Columbia
Medizinische Universitat Innsbruck
Universitair Medisch Centrum Groningen
Peking University Health Science Center
University of Mississippi Medical Center
University of Pennsylvania Perelman School of Medicine
Universitätsklinikum Heidelberg
Universiteit van Amsterdam
Ottawa Hospital Research Institute
Seoul National University College of Medicine
Postgraduate Institute of Medical Education & Research, Chandigarh
Hemodialysis Unit
Pro-rim Foundation
BC Provincial Renal Agency
Nephrological Center
Faculty of Medicine
Nagoya University Graduate School of Medicine
Arbor Research Collaborative for Health
Peking University First Hospital
Amsterdam Public Health
Centre de Recherche en Épidémiologie et Santé des Populations
George Institute for Global Health
University of Nottingham Medical School
The University of Queensland
Tokai University School of Medicine
Charité – Universitätsmedizin Berlin
University of Nigeria
GlaxoSmithKline plc.
Imperial College Faculty of Medicine
Pontifícia Universidade Católica do Paraná
University of Birmingham
Monash University
Universidade da Regiao de Joinville
Faculty of Medicine Ramathibodi Hospital, Mahidol University
Seoul National University
The University of British Columbia
Medizinische Universitat Innsbruck
Universitair Medisch Centrum Groningen
Peking University Health Science Center
University of Mississippi Medical Center
University of Pennsylvania Perelman School of Medicine
Universitätsklinikum Heidelberg
Universiteit van Amsterdam
Ottawa Hospital Research Institute
Seoul National University College of Medicine
Postgraduate Institute of Medical Education & Research, Chandigarh
Hemodialysis Unit
Pro-rim Foundation
BC Provincial Renal Agency
Nephrological Center
Other Contributor(s)
Abstract
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.