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Abstract: PO1965

Hemoglobin and Mortality Across Race Among Children Who Transitioned to Dialysis Therapy: An Analysis of CEFDIM and USRDS Data

Session Information

Category: Pediatric Nephrology

  • 1700 Pediatric Nephrology

Authors

  • Tronske, Michael, University of California Irvine, Irvine, California, United States
  • Laster, Marciana, University of California Los Angeles, Los Angeles, California, United States
  • Hsiung, Jui-Ting, University of California Irvine, Irvine, California, United States
  • Kalantar-Zadeh, Kamyar, University of California Irvine, Irvine, California, United States
  • Streja, Elani, University of California Irvine, Irvine, California, United States
Background

Low hemoglobin (Hgb) is a strong predictor for mortality in adult dialysis patients, and children on dialysis experience optimal Hgb levels less frequently than adults. Racial disparities have also been identified in pediatric dialysis patients, with Blacks experiencing unfavorable clinical outcomes and poor access compared to Whites. However, there is less literature examining the impact of race on the association of Hgb with mortality among pediatric patients on dialysis.

Methods

We retrospectively studied two cohorts of children (age <21) using data from a large dialysis organization (CEFDIM) and a national data system (USRDS). CEFDIM (n=1069) were followed from 2006-2011, while USRDS (n=26,254) were followed from 1995-2016. The association between Hgb and mortality was observed using Cox regression analyses stratified by race, categorizing Hgb by g/dL as well as z scores (ref: Hgb 11-12g/dL, z scores -0.5 to 0.5). Covariates considered in the models included age, sex, BMI, albumin, comorbidities, and dialysis modality type.

Results

Among Black CEFDIM patients, Hgb <10g/dL was associated with increased mortality (7.9 [0.97,65.27]), as was Hgb z scores <-1.5 (8.62 [1.92,38.77]). Among White CEFDIM patients, these associations were null, and no deaths occurred for z scores <-1.5. Among Black USRDS patients, Hgb above 12 g/dL appears to be protective (0.83 [0.65,1.06]), which was not a protective range for White patients. Meanwhile z scores <-1.5 were significantly protective among White patients (0.82 [0.70,0.96]), but not among Black patients (0.94 [0.79,1.13]).

Conclusion

In children undergoing dialysis, protective Hgb target ranges appear to differ by race, with White children experiencing lower mortality risk from extremely low values and Black children receiving protection from high values.