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Publications

Journal Article Multicenter Study Research Support, N.I.H., Extramural Ppublish 41 citations

PubMed: 32289161 DOI: 10.1182/bloodadvances.2019001378

Progression of albuminuria in patients with sickle cell anemia: a multicenter, longitudinal study.

Blood Adv 4(7):1501-1511

Authors: Omar Niss, Adam Lane, Monika R Asnani, Marianne E Yee, Ashok Raj, Susan Creary, Courtney Fitzhugh, Prasad Bodas, Santosh L Saraf, Sharada Sarnaik, Prasad Devarajan, Punam Malik

Affiliations

  • Division of Hematology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH.
  • Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH.
  • Division of Bone Marrow Transplantation, Cincinnati Children's Hospital Medical Center, Cincinnati, OH.
  • Sickle Cell Unit, Caribbean Institute for Health Research, University of the West Indies, Kingston, Jamaica.
  • Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, GA.
  • Department of Pediatrics, Emory University School of Medicine, Atlanta, GA.
  • Department of Pediatrics, University of Louisville, Louisville, KY.
  • Center for Innovation in Pediatric Practice, Division of Pediatric Hematology/Oncology/BMT, Nationwide Children's Hospital, Columbus, OH.
  • Hematology Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD.
  • Akron Children's Hospital, Akron, OH.
  • Division of Hematology Oncology, Department of Medicine, University of Illinois at Chicago, Chicago, IL.
  • Children's Hospital of Michigan, Detroit, MI; and.
  • Division of Nephrology and.
  • Division of Experimental Hematology and Cancer Biology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH.

Abstract

Sickle cell nephropathy results in chronic kidney disease (CKD), which is associated with significant morbidity and mortality in sickle cell anemia (SCA). Albuminuria is an early manifestation of sickle nephropathy; however, little is known about progression of albuminuria or its correlation with glomerular filtration rate (GFR) decline or CKD. We studied nephropathy progression in 303 SCA participants in a prospective, multicenter, longitudinal study. We collected steady-state urine and serum samples yearly and assessed albumin/creatinine ratio (ACR), estimated GFR (eGFR), and SCA and nephropathy biomarkers. Participants with albuminuria (ACR ≥30 mg/g) for ≥2 annual measurements were classified as having persistent albuminuria (PA). At baseline (mean age, 21 years; range, 2-64 years), 32% had albuminuria. In longitudinal multivariate analysis, ACR was associated with sex, anemia, older age, and higher bilirubin and kidney injury molecule-1 levels. Albuminuria increased with age by 3.5 mg/g per year (P < .0001). Of 175 participants with ≥3 annual samples, 81% with baseline albuminuria ≥100 mg/g developed PA. Decreased eGFR and adult CKD were associated with PA (P = .002 and P = .02, respectively), but not with baseline albuminuria. Rate of eGFR decline was steeper among adults (but not children) with albuminuria, compared with those without (P = .02). Participants with PA were more likely to have rapid eGFR decline compared with those without (P = .03). In this longitudinal study, albuminuria progressed with age, and adults with albuminuria had worse eGFR decline than those without. Albuminuria ≥100 mg/g predicted PA, which was associated with rapid eGFR decline and CKD development in adults with SCA. This trial was registered at www.clinicaltrials.gov as #NCT02239016.

MeSH

Cells, Longitudinal Studies, Anemia, Sickle Cell, Anemia, Albuminuria, Kidney, Hematologic Diseases

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