Regional Variation in Hemoglobin Distribution Among Individuals With CKD: the ISN International Network of CKD Cohorts

作者：Mark Canney, Dilshani Induruwage, Mila Tang, Natália Alencar de Pinho, Lee Er, Yinshan Zhao, Ognjenka Djurdjev, Yo Han Ahn, Rouven Behnisch, Viviane Cálice-Silva, Nicholas C Chesnaye, Martin H. de Borst, Laura M. Dember, Janis M. Dionne, Natalie Ebert, Susanne Eder, Anthony Fenton, Masafumi Fukagawa, Susan L. Furth, Wendy E. Hoy, Takahiro Imaizumi, Kitty J. Jager, Vivekanand Jha, Hee Gyung Kang, Chagriya Kitiyakara, Gert Mayer, Kook‐Hwan Oh, Ugochi Onu, Roberto Pecoits-Filho, Helmut Reichel, Anna Richards, Franz Schaefer, Elke Schäeffner, Johannes B. Scheppach, Laura Solá, Ifeoma Ulasi, Jinwei Wang, Ashok Kumar Yadav, Jianzhen Zhang, Harold I. Feldman, Maarten W. Taal, Bénédicte Stengel, Adeera Levin, Curie Ahn, Stefan P. Berger, Fergus Caskey, Min Hyun Cho, Heeyeon Cho, Friedo W. Dekker, Vishal Diwan, Christiane Drechsler, Kai‐Uwe Eckardt, Marie Evans, Alejandro Ferreiro, Jürgen Floege, Liliana Gadola, Hermann Haller, Kyung Hee Han, Helen Healy, Hiddo J.L. Heerspink, Marc H. Hemmelder, Thomas F. Hiemstra, Luuk B. Hilbrands, Seong Heon Kim, Pinkaew Klyprayong, Anna Köttgen, Florian Kronenberg, Verónica Lamadrid, Joo Hoo Lee, Patrick B. Mark, Matt Matheson, Eun Mi, Kajohnsak Noppakun, Peter J. Oefner, Thanachai Panaput, Young Seo Park, Hans‐Ulrich Prokosch, André Reis, Pablo Ríos, László Rosivall, Joris I. Rotmans, Alfred Sackeyfio, Pornpen Sangthawan, Matthias Schmid, Jae Il Shin, Ricardo Silavarino, Thomas Sitter, Claudia Sommerer, Maciej Szymczak, Claudia Torino, János Tóth, Frans J. van Ittersum, Sree Krishna Venuthurupalli, Marianne C. Verhaar, Zaimin Wang, Christoph Wanner, Andrzej Więcek, Günter Wolf, Dick de Zeeuw, Luxia Zhang, Yuyan Zheng, Ming‐Hui Zhao, Robert Zietse · 发表于：Kidney International Reports · 年份：2023 · DOI：10.1016/j.ekir.2023.07.032 · 被引用次数：13 · 研究领域：Erythropoietin and Anemia Treatment、Chronic Kidney Disease and Diabetes、Hemoglobinopathies and Related Disorders

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 varianc...