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Anemia and Risk of Hospitalization in Pediatric Chronic Kidney Disease

Amy O. Staples^*, Craig S. Wong^*, Jodi M. Smith, Debbie S. Gipson, Guido Filler, Bradley A. Warady^||, Karen Martz^¶, and Larry A. Greenbaum^**

^* Division of Pediatric Nephrology, University of New Mexico, Albuquerque, New Mexico; Division of Nephrology, Children's Hospital and Regional Medical Center, Seattle, Washington; Division of Nephrology and Hypertension, University of North Carolina–Chapel Hill, Chapel Hill, North Carolina; Division of Nephrology, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada; ^|| Section of Pediatric Nephrology, The Children's Mercy Hospital, Kansas City, Missouri; ^¶ EMMES Corporation, Rockville, Maryland; and ^** Division of Pediatric Nephrology, Emory University and Children's Healthcare of Atlanta, Atlanta, Georgia

Correspondence: Dr. Amy Staples, MPH, Division of Pediatric Nephrology, University of New Mexico, MSC10-5590, 1 University of New Mexico, Albuquerque, NM 87131. Phone: 505-272-3887; Fax: 505-272-6620; E-mail: astaples{at}salud.unm.edu

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: 2779 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 nonanemic 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 predialysis 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.