Sickle cell disease tied to rapid eGFR decline over time

  • Derebail VK & al.
  • Am J Kidney Dis
  • 20 Feb 2019

  • curated by Dawn O'Shea
  • International Clinical Digest
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Takeaway

  • Sickle cell disease (SCD) is associated with a rapid decline in estimated glomerular filtration rate (eGFR) over time.

Why this matters

  • Decline is sharper with more severe disease forms, such as sickle cell anaemia (HbSS) or sickle β0 thalassaemia (HbSβ0).
  • Traditional risk factors play a key role in milder forms (haemoglobin SC disease [HbSC], sickle β+ thalassaemia [HbSβ+]).

Study design

  • Cohort study of 427 patients with SCD; 331 had ≥2 creatinine measurements.
  • Most common forms were HbSS (63.0%) and HbSC (23.0%).
  • Median follow-up, 4.01 years.
  • Funding: US National Heart, Lung, and Blood Institute.

Key results

  • Baseline chronic kidney disease (CKD) was more common in severe vs mild genotypes (21.4% vs 17.2%).
  • Annual eGFR decline:
    • 2.05 mL/min/1.73m2 for severe genotypes (P<.001>
    • 1.16 mL/min/1.73m2 for mild genotypes (P=.02).
  • In mild SCD genotypes, higher haemoglobin was tied to lower odds of CKD (OR per 1 g/dL rise, 0.63; P=.02).
    • Rate of eGFR decline was associated with factors such as diabetes and blood pressure.
  • In severe genotypes, rate of eGFR decline was inversely related to haemoglobin level (per 1g/dL increase, 0.46 mL/min/1.73m2; P=.04).
  • Patients with severe genotypes and CKD were more likely to be taking angiotensin converting enzyme inhibitors/angiotensin receptor blockers (OR=6.10; P=.04).

Limitations

  • Retrospective, observational, monocentric design.