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Anemia and Risk of Hospitalization in Pediatric Chronic Kidney Disease


Journal Article

Staples, A.O.; Wong, C.S.; Smith, J.M.; Gipson, D.S.; Filler, G.; Warady, B.A.; Martz, K.; Greenbaum, L.A.

Clin J Am Soc Nephrol




Adolescent; anemia; Canada; Child; chronic disease; Erythropoietin; Female; Hematinics; Hematocrit; Hospitalization; Kidney Diseases; Logistic Models; Male; Odds Ratio; Preschool; Prevalence; Registries; Retrospective Studies; Risk Assessment

BACKGROUND AND OBJECTIVES: Anemia is a well known complication of chronic kidney disease (CKD); however, the prevalence of anemia within CKD stages in the pediatric population has not been established. Additionally, the associated morbidity of anemia in the pediatric CKD population has not been elucidated. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: 2,779 patients ages 2 yr and older in the North American Pediatric Renal Trials and Collaborative Studies database with CKD stage II to V (excluding dialysis or previous transplant patients) were identified. Descriptive statistics and multivariate modeling using logistic regression was performed to determine the prevalence of anemia and to evaluate the correlation between baseline anemia and hospitalization. RESULTS: The prevalence of anemia (hematocrit < 33%) increased from 18.5% in CKD stage II to 68% in CKD stage V (predialysis). Anemic children were 55% more likely to be hospitalized when compared with non-anemic children (odds ratio 1.55; 95% confidence interval 1.23 to 1.94). Similar results were obtained using hematocrit cutoffs of 36 and 39%. CONCLUSIONS: In this pediatric pre-dialysis CKD population, anemia increases with increasing CKD stage and is significantly associated with hospitalization risk. Hematocrit levels above 36 and 39% were not associated with increased risk of hospitalization. Further examination into the effect of correcting anemia on hospitalization rates may provide additional useful information.

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