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Comparative Study Journal Article Research Support, N.I.H., Extramural Research Support, Non-U.S. Gov't Ppublish 97 citations

PubMed: 26672090 DOI: 10.2215/CJN.03940415

Kidney Disease among Patients with Sickle Cell Disease, Hemoglobin SS and SC.

Clin J Am Soc Nephrol 11(2):207-15

Authors: Paul Drawz, Sabarish Ayyappan, Mehdi Nouraie, Santosh Saraf, Victor Gordeuk, Thomas Hostetter, Mark T Gladwin, Jane Little

Affiliations

  • Division of Renal Diseases and Hypertension, University of Minnesota, Minneapolis, Minnesota
  • Divisions of Hematology and Oncology, and.
  • Center for Sickle Cell Disease, Howard University, Washington, DC
  • Division of Hematology/Oncology, University of Illinois, Chicago, Illinois; and.
  • Comprehensive Sickle Cell Center.
  • Nephrology and Hypertension,University Hospitals Case Medical Center, Case Western Reserve University, Cleveland, Ohio
  • Vascular Medicine Institute and Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania.
  • Divisions of Hematology and Oncology, and.

Abstract

BACKGROUND AND OBJECTIVES

Sickle cell disease (SCD) is an inherited anemia that afflicts millions worldwide. Kidney disease is a major contributor to its morbidity and mortality. We examined contemporary and historical SCD populations to understand how renal disease behaved in hemoglobin SS (HbSS) compared with HbSC.

DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS

Kidney function was examined in the multicentered Treatment of Pulmonary Hypertension and Sickle Cell Disease with Sildenafil Therapy (Walk-PHaSST) Trial (HbSS=463; HbSC=127; years 2007-2009) and historical comparator populations from the Cooperative Study of Sickle Cell Disease (CSSCD; HbSS=708) and the Multicenter Study of Hydroxyurea in Sickle Cell Disease (MSH; HbSS=299).

RESULTS

In adults with SCD, eGFR was lower among older individuals: -1.78 ml/min per 1.73 m(2) per year of age (95% confidence interval [95% CI], -2.06 to -1.50; Walk-PHaSST Trial), -1.75 ml/min per 1.73 m(2) per year of age (95% CI, -2.05 to -1.44; MSH), and -1.69 ml/min per 1.73 m(2) per year of age (95% CI, -2.00 to -1.38; CSSCD) in HbSS compared with -1.09 ml/min per 1.73 m(2) per year of age (95% CI, -1.39 to -0.75) in HbSC (Walk-PHaSST Trial). Macroalbuminuria was seen in 20% of participants with SCD (HbSS or HbSC; P=0.45; Walk-PHaSST Trial), but microalbuminuria was more prevalent in HbSS (44% versus 23% in HbSC; P<0.002). In the Walk-PHaSST Trial, albuminuria was associated with hemolysis (higher lactate dehydrogenase, P<0.001; higher absolute reticulocyte count, P<0.02; and lower Hb, P=0.07) and elevated systolic BP (P<0.001) in HbSS. One half of all participants with HbSS (20 of 39) versus one fifth without (41 of 228) elevated tricuspid regurgitant jet velocity (≥3 m/s; adverse prognostic indicator in SCD) had macroalbuminuria (P<0.001). In the CSSCD, overt proteinuria, detected (less sensitively) by urine dipstick, associated with higher 3-year mortality (odds ratio, 2.48; 95% CI, 1.07 to 5.77). Serum bicarbonate was lower in HbSS (23.8 versus 24.8 mEq/dl in HbSC; P<0.05) and associated with reticulocytopenic anemia and decreased renal function.

CONCLUSIONS

In SCD, albuminuria or proteinuria was highly prevalent, in HbSS more than in HbSC. Proteinuria associated with mortality in HbSS. Older individuals had a lower than expected eGFR, and this was more prominent in HbSS. Current management does not routinely address renal complications in SCD, which could plausibly reduce morbidity and mortality.

MeSH

Morbidity, Mortality, Anemia, Sickle Cell, Proteinuria, Acidosis, Glomerular Filtration Rate, Kidney Diseases, Albuminuria, Hydroxyurea, Cells, Therapeutics, Nephrology, Blood Pressure, Hemoglobins

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