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Valle J, Lebensburger JD, Garimella PS, Gopal S. Prevalence, Mortality, and Access to Care for Chronic Kidney Disease in Medicaid-Enrolled Adults With Sickle Cell Disease in California: Retrospective Cohort Study. JMIR Public Health Surveill 2024; 10:e57290. [PMID: 39008353 PMCID: PMC11287091 DOI: 10.2196/57290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2024] [Revised: 03/25/2024] [Accepted: 05/17/2024] [Indexed: 07/16/2024] Open
Abstract
BACKGROUND Chronic kidney disease (CKD) is a significant complication in patients with sickle cell disease (SCD), leading to increased mortality. OBJECTIVE This study aims to investigate the burden of CKD in Medicaid-enrolled adults with SCD in California, examine differences in disease burden between male and female individuals, and assess mortality rates and access to specialized care. METHODS This retrospective cohort study used the California Sickle Cell Data Collection program to identify and monitor individuals with SCD. Medicaid claims, vital records, emergency department, and hospitalization data from 2011 to 2020 were analyzed. CKD prevalence was assessed based on ICD (International Classification of Diseases) codes, and mortality rates were calculated. Access to specialized care was examined through outpatient encounter rates with hematologists and nephrologists. RESULTS Among the 2345 adults with SCD, 24.4% (n=572) met the case definition for CKD. The SCD-CKD group was older at the beginning of this study (average age 44, SD 14 vs 34, SD 12.6 years) than the group without CKD. CKD prevalence increased with age, revealing significant disparities by sex. While the youngest (18-29 years) and oldest (>65 years) groups showed similar CKD prevalences between sexes (female: 12/111, 10.8% and male: 12/101, 11.9%; female: 74/147, 50.3% and male: 34/66, 51.5%, respectively), male individuals in the aged 30-59 years bracket exhibited significantly higher rates than female individuals (30-39 years: 49/294, 16.7%, P=.01; 40-49 years: 52/182, 28.6%, P=.02; and 50-59 years: 76/157,48.4%, P<.001). During this study, of the 2345 adults, 435 (18.5%) deaths occurred, predominantly within the SCD-CKD cohort (226/435, 39.5%). The median age at death was 53 (IQR 61-44) years for the SCD-CKD group compared to 43 (IQR 33-56) years for the SCD group, with male individuals in the SCD-CKD group showing significantly higher mortality rates (111/242, 45.9%; P=.009) than female individuals (115/330, 34.9%). Access to specialist care was notably limited: approximately half (281/572, 49.1%) of the SCD-CKD cohort had no hematologist visits, and 61.9% (354/572) did not see a nephrologist during this study's period. CONCLUSIONS This study provides robust estimates of CKD prevalence and mortality among Medicaid-enrolled adults with SCD in California. The findings highlight the need for improved access to specialized care for this population and increased awareness of the high mortality risk and progression associated with CKD.
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Affiliation(s)
- Jhaqueline Valle
- Tracking California, Public Health Institute, Oakland, CA, United States
| | - Jeffrey D Lebensburger
- Division of Pediatric Hematology-Oncology, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Pranav S Garimella
- Division of Nephrology-Hypertension, Department of Medicine, University of California San Diego, San Diego, CA, United States
| | - Srila Gopal
- Division of Hematology/Oncology, Department of Medicine, University of California San Diego, La Jolla, CA, United States
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2
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Zhou LY, Derebail VK, Desai PC, Elsherif L, Patillo KL, McCune P, Wichlan D, Landes K, Ogu UO, Nelson M, Loehr LR, Cronin RM, Tang Y, Cai J, Ataga KI. Persistent albuminuria and chronic kidney disease in adults with sickle cell anaemia: Results from a multicenter natural history study. Br J Haematol 2024. [PMID: 38978309 DOI: 10.1111/bjh.19636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2024] [Accepted: 06/27/2024] [Indexed: 07/10/2024]
Abstract
Clinical and laboratory correlates of chronic kidney disease (CKD) in sickle cell anaemia remain incompletely defined. In a multicenter cohort study, we evaluated the prevalence of persistent albuminuria (PA) and characteristics associated with PA, albumin-creatinine ratio (ACR) and decreased estimated glomerular filtration rate (eGFR) using logistic, linear and multinomial regression models, respectively. Of 269 participants (median age: 30 years; 57.2% females), the prevalence of PA was 35.7%. Using baseline ACR values of <100 and ≥100 mg/g, the probabilities of PA were 30.0% and 94.6%, respectively. In multivariable logistic regression analyses, male sex (β = 0.80 [SE = 0.36], p = 0.024) and ACE inhibitors/ARBs use (β = 1.54 [SE = 0.43], p < 0.001) were associated with higher likelihoods of PA, while higher haemoglobin (β = -0.33 [SE = 0.13], p = 0.009) and HbF (β = -0.04 [SE = 0.02], p = 0.041) were associated with lower likelihoods of PA. In multivariable multinomial regression analyses, older age (β = 0.06 [SE = 0.02], p = 0.004) and higher alkaline phosphatase (β = 0.01 [SE = 0.00], p = 0.004) were associated with higher odds of having eGFR 60-90 versus eGFR>90 mL/min/1.73 m2 using the cystatin C-based CKD-EPI-2012 equation. Additionally, higher systolic blood pressure (β = 0.11 [SE = 0.03], p = 0.001) and blood urea nitrogen (β = 0.45 [SE = 0.12], p < 0.001) were associated with higher odds, while higher haemoglobin (β = -1.22 [SE = 0.43], p = 0.004) was associated with lower odds of having eGFR<60 versus eGFR>90 mL/min/1.73 m2. PA and decreased eGFR are associated with measures of disease severity and comorbid conditions (Clinicaltrials.gov Identifier: NCT03277547).
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Affiliation(s)
- Laura Y Zhou
- Department of Biostatistics and Health Data Science, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Vimal K Derebail
- Division of Nephrology and Hypertension, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Payal C Desai
- Department of Hematology, Levine Cancer Institute-Atrium Health, Charlotte, North Carolina, USA
| | - Laila Elsherif
- Center for Sickle Cell Disease, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Kammie L Patillo
- Office of Clinical Trials, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Paula McCune
- Office of Clinical Trials, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - David Wichlan
- Division of Hematology, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Kristina Landes
- Division of Hematology, The Ohio State University, Columbus, Ohio, USA
| | - Ugochi O Ogu
- Center for Sickle Cell Disease, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Marquita Nelson
- Center for Sickle Cell Disease, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Laura R Loehr
- Division of General Medicine and Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Robert M Cronin
- Department of Internal Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Yihan Tang
- Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Jianwen Cai
- Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Kenneth I Ataga
- Center for Sickle Cell Disease, University of Tennessee Health Science Center, Memphis, Tennessee, USA
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3
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Davila J, O'Brien SH, Mitchell WB, Manwani D. Evaluating thromboprophylaxis in the sickle cell disease population: Navigating the evidence gap. Br J Haematol 2024; 204:2184-2193. [PMID: 38578212 DOI: 10.1111/bjh.19428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 02/08/2024] [Accepted: 03/14/2024] [Indexed: 04/06/2024]
Abstract
Sickle cell disease (SCD) arises from beta-globin gene mutations, with global estimates indicating around 500 000 affected neonates in 2021. In the United States, it is considered rare, impacting fewer than 200 000 individuals. The key pathogenic flaw lies in mutant haemoglobin S, prone to polymerization under low oxygen conditions, causing erythrocytes to adopt a sickled shape. This leads to complications like vascular occlusion, haemolytic anaemia, inflammation and organ damage. Beyond erythrocyte abnormalities however, there is a body of literature highlighting the hypercoagulable state that is likely a contributor to many of the complications we see in SCD. The persistent activation of the coagulation cascade results in thromboembolic events, notably venous thromboembolism (VTE) which is independently associated with increased mortality in both adults and children with SCD. While the increased risk of VTE in the SCD population seems well established, there is a lack of guidelines for thromboprophylaxis in this population. This Wider Perspective will describe the hypercoagulable state and increased thrombosis risk in the SCD population, as well as advocate for the development of evidence-based guidelines to aid in the prevention of VTE in SCD.
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Affiliation(s)
- Jennifer Davila
- Division of Pediatric Hematology-Oncology, Department of Pediatrics, Albert Einstein College of Medicine, Children's Hospital at Montefiore, Bronx, New York, USA
| | - Sarah H O'Brien
- Division of Pediatric Hematology/Oncology, Nationwide Children's Hospital/The Ohio State University, Columbus, Ohio, USA
| | - William B Mitchell
- Division of Pediatric Hematology-Oncology, Department of Pediatrics, Albert Einstein College of Medicine, Children's Hospital at Montefiore, Bronx, New York, USA
| | - Deepa Manwani
- Division of Pediatric Hematology-Oncology, Department of Pediatrics, Albert Einstein College of Medicine, Children's Hospital at Montefiore, Bronx, New York, USA
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4
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Garrett ME, Foster MW, Telen MJ, Ashley-Koch AE. Nontargeted Plasma Proteomic Analysis of Renal Disease and Pulmonary Hypertension in Patients with Sickle Cell Disease. J Proteome Res 2024; 23:1039-1048. [PMID: 38353026 DOI: 10.1021/acs.jproteome.3c00748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Abstract
Sickle cell disease (SCD) is characterized by red blood cell sickling, vaso-occlusion, hemolytic anemia, damage to multiple organ systems, and, as a result, shortened life expectancy. Sickle cell disease nephropathy (SCDN) and pulmonary hypertension (pHTN) are common and frequently co-occurring complications of SCD; both are associated with markedly accelerated mortality. To identify candidate circulating biomarkers of SCDN and pHTN, we used mass spectrometry to quantify the relative abundance of >1000 proteins in plasma samples from 189 adults with SCD from the Outcome Modifying Genes in SCD (OMG-SCD) cohort (ProteomeXchange identifier PXD048716). Forty-four proteins were differentially abundant in SCDN, most significantly cystatin-C and collagen α-1(XVIII) chain (COIA1), and 55 proteins were dysregulated in patients with SCDN and pHTN, most significantly insulin-like growth factor-binding protein 6 (IBP6). Network analysis identified a module of 133 coregulated proteins significantly associated with SCDN, that was enriched for extracellular matrix proteins, insulin-like growth factor binding proteins, cell adhesion proteins, EGF-like calcium binding proteins, and several cadherin family members. Collectively, these data provide a comprehensive understanding of plasma protein changes in SCDN and pHTN which validate numerous studies of chronic kidney disease and suggest shared profiles of protein disruption in kidney dysfunction and pHTN among SCD patients.
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Affiliation(s)
- Melanie E Garrett
- Duke Molecular Physiology Institute, Duke University Medical Center, Durham, North Carolina 27701, United States
| | - Matthew W Foster
- Department of Medicine, Division of Pulmonary, Allergy and Critical Care, Duke University Medical Center, Durham, North Carolina 27701, United States
- Duke Proteomics and Metabolomics Core Facility, Duke University School of Medicine, Durham, North Carolina 27701, United States
| | - Marilyn J Telen
- Department of Medicine, Division of Hematology and Duke Comprehensive Sickle Cell Center, Duke University Medical Center, Durham, North Carolina 27701, United States
| | - Allison E Ashley-Koch
- Duke Molecular Physiology Institute, Duke University Medical Center, Durham, North Carolina 27701, United States
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5
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Elsabagh AA, Elhadary M, Elsayed B, Elshoeibi AM, Ferih K, Kaddoura R, Alkindi S, Alshurafa A, Alrasheed M, Alzayed A, Al-Abdulmalek A, Altooq JA, Yassin M. Artificial intelligence in sickle disease. Blood Rev 2023; 61:101102. [PMID: 37355428 DOI: 10.1016/j.blre.2023.101102] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 05/12/2023] [Accepted: 06/01/2023] [Indexed: 06/26/2023]
Abstract
Artificial intelligence (AI) is rapidly becoming an established arm in medical sciences and clinical practice in numerous medical fields. Its implications have been rising and are being widely used in research, diagnostics, and treatment options for many pathologies, including sickle cell disease (SCD). AI has started new ways to improve risk stratification and diagnosing SCD complications early, allowing rapid intervention and reallocation of resources to high-risk patients. We reviewed the literature for established and new AI applications that may enhance management of SCD through advancements in diagnosing SCD and its complications, risk stratification, and the effect of AI in establishing an individualized approach in managing SCD patients in the future. Aim: to review the benefits and drawbacks of resources utilizing AI in clinical practice for improving the management for SCD cases.
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Affiliation(s)
| | | | - Basel Elsayed
- College of Medicine, QU Health, Qatar University, Doha, Qatar
| | | | - Khaled Ferih
- College of Medicine, QU Health, Qatar University, Doha, Qatar
| | - Rasha Kaddoura
- Pharmacy Department, Heart Hospital, Hamad Medical Corporation (HMC), Doha, Qatar
| | - Salam Alkindi
- Professor of Hematology, Sultan Qaboos University, Oman
| | - Awni Alshurafa
- Department of Hematology, Hamad Medical Corporation (HMC), Doha, Qatar
| | - Mona Alrasheed
- Hematology Unit, Department of Medicine, Aladnan Hospital, Ministry of Health, Kuwait
| | | | | | | | - Mohamed Yassin
- Hematology Section, Medical Oncology, National Center for Cancer Care and Research (NCCCR), Hamad Medical Corporation (HMC), Doha, Qatar.
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6
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Farris N, Benoit SW, McNinch NL, Bodas P. Urinary Biomarkers for the Assessment of Acute Kidney Injury of Pediatric Sickle Cell Anemia Patients Admitted for Severe Vaso-occlusive Crises. J Pediatr Hematol Oncol 2023; 45:309-314. [PMID: 36898013 DOI: 10.1097/mph.0000000000002642] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 12/20/2022] [Indexed: 03/12/2023]
Abstract
Sickle cell nephropathy is a progressive morbidity, beginning in childhood, which is incompletely understood partially due to insensitive measures. We performed a prospective pilot study of pediatric and young adult patients with sickle cell anemia (SCA) to assess urinary biomarkers during acute pain crises. Four biomarkers were analyzed with elevations potentially suggesting acute kidney injury: (1) neutrophil gelatinase-associated lipocalin (NGAL), (2) kidney injury molecule-1, (3) albumin, and (4) nephrin. Fourteen unique patients were admitted for severe pain crises and were found to be representative of a larger SCA population. Urine samples were collected at the time of admission, during admission, and at follow-up after discharge. Exploratory analyses compared cohort values to the best available population values; individuals were also compared against themselves at various time points. Albumin was found to be moderately elevated for an individual during admission compared with follow-up ( P = 0.006, Hedge g : 0.67). Albumin was not found to be elevated compared with population values. Neutrophil gelatinase-associated lipocalin, kidney injury molecule-1, and nephrin were not found to be significantly elevated compared with population values or comparing admission to follow-up. Though albumin was found to be minimally elevated, further research should focus on alternative markers in efforts to further understand kidney disease in patients with SCA.
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Affiliation(s)
- Nicholas Farris
- Division of Pediatric Hematology Oncology, University of Rochester, Rochester, NY
- Division of Hematology Oncology Akron Children's Hospital
| | - Stefanie W Benoit
- Division of Nephrology and Hypertension, Cincinnati Children's Hospital Medical Center
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Neil L McNinch
- Division of Hematology Oncology Akron Children's Hospital
- Rebecca D. Considine Research Institute at Akron Children's Hospital, Akron
| | - Prasad Bodas
- Division of Hematology Oncology Akron Children's Hospital
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7
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Castro-Sesquen YE, Saraf SL, Gordeuk VR, Nekhai S, Jerebtsova M. Use of multiple urinary biomarkers for the early detection of chronic kidney disease in sickle cell anemia. Blood Adv 2023; 7:2606-2608. [PMID: 36634264 PMCID: PMC10250912 DOI: 10.1182/bloodadvances.2022008006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 12/08/2022] [Accepted: 01/05/2023] [Indexed: 01/13/2023] Open
Affiliation(s)
| | - Santosh L. Saraf
- Section of Hematology-Oncology, Department of Medicine, University of Illinois Chicago, Chicago, IL
| | - Victor R. Gordeuk
- Section of Hematology-Oncology, Department of Medicine, University of Illinois Chicago, Chicago, IL
| | - Sergei Nekhai
- Department of Microbiology, Howard University, Washington, DC
- Center for Sickle Cell Disease, Howard University, Washington, DC
- Department of Medicine, College of Medicine, Howard University, Washington, DC
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8
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Elsherif L, Kanthakumar P, Afolabi J, Stratton AF, Ogu U, Nelson M, Mukhopadhyay A, Smeltzer MP, Adebiyi A, Ataga KI. Urinary angiotensinogen is associated with albuminuria in adults with sickle cell anaemia. Br J Haematol 2023. [PMID: 37189288 DOI: 10.1111/bjh.18862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 04/25/2023] [Accepted: 05/03/2023] [Indexed: 05/17/2023]
Abstract
We explored the association of novel urinary biomarkers with albumin-creatinine ratio (ACR) in adults with sickle cell anaemia. Of 37 participants, 13 (35.2%) had persistent albuminuria (PA). Urinary levels of clusterin (p = 0.002), retinol-binding protein 4 (p = 0.008), alpha-1 microglobulin (p = 0.002) and angiotensinogen (p = 0.006) were significantly higher in participants with PA than in those without PA. Although univariate analysis showed significant associations between both alpha-1 microglobulin (p = 0.035) and angiotensinogen (p = 0.0021) with ACR, only angiotensinogen was associated with ACR in multivariable analysis (p = 0.04). Our results suggest that urinary angiotensinogen may identify sickle cell anaemia patients at risk for kidney disease.
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Affiliation(s)
- Laila Elsherif
- Center for Sickle Cell Disease, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Praghalathan Kanthakumar
- Department of Physiology, University of Tennessee Health Scienter Center, Memphis, Tennessee, USA
| | - Jeremiah Afolabi
- Department of Physiology, University of Tennessee Health Scienter Center, Memphis, Tennessee, USA
| | - Ashley F Stratton
- Department of Pediatrics, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Ugochi Ogu
- Center for Sickle Cell Disease, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Marquita Nelson
- Center for Sickle Cell Disease, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Ayesha Mukhopadhyay
- Division of Epidemiology, Biostatistics and Environmental Health, The University of Memphis, Memphis, Tennessee, USA
| | - Matthew P Smeltzer
- Division of Epidemiology, Biostatistics and Environmental Health, The University of Memphis, Memphis, Tennessee, USA
| | - Adebowale Adebiyi
- Department of Physiology, University of Tennessee Health Scienter Center, Memphis, Tennessee, USA
| | - Kenneth I Ataga
- Center for Sickle Cell Disease, University of Tennessee Health Science Center, Memphis, Tennessee, USA
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9
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Ataga KI, Zhou Q, Saraf SL, Hankins JS, Ciccone EJ, Loehr LR, Garrett ME, Ashley-Koch AE, Cai J, Telen MJ, Derebail VK. Sex differences in progression of kidney disease in sickle cell disease. Haematologica 2023; 108:1436-1441. [PMID: 36546431 PMCID: PMC10153522 DOI: 10.3324/haematol.2022.281677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 12/05/2022] [Indexed: 12/24/2022] Open
Affiliation(s)
- Kenneth I Ataga
- Center for Sickle Cell Disease, University of Tennessee Health Scienter Center, Memphis, TN.
| | - Qingning Zhou
- Department of Mathematics and Statistics, University of North Carolina at Charlotte, Charlotte, NC
| | | | - Jane S Hankins
- Department of Hematology, St. Jude Children's Research Hospital, Memphis, TN
| | - Emily J Ciccone
- Division of Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Laura R Loehr
- Division of General Medicine and Clinical Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Melanie E Garrett
- Duke Molecular Physiology Institute, Duke University Medical Center, Durham, NC
| | | | - Jianwen Cai
- Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Marilyn J Telen
- Division of Hematology, Duke University Medical Center, Durham, NC
| | - Vimal K Derebail
- UNC Kidney Center, Division of Nephrology and Hypertension, University of North Carolina at Chapel Hill, Chapel Hill, NC
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10
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Lebensburger JD, Derebail VK. Sickle Cell Disease and the Kidney. Hematol Oncol Clin North Am 2022; 36:1239-1254. [DOI: 10.1016/j.hoc.2022.08.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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11
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Afangbedji N, Jerebtsova M. Glomerular filtration rate abnormalities in sickle cell disease. Front Med (Lausanne) 2022; 9:1029224. [PMID: 36341242 PMCID: PMC9633850 DOI: 10.3389/fmed.2022.1029224] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 10/04/2022] [Indexed: 12/03/2022] Open
Abstract
Sickle cell disease (SCD) is a group of inherited blood disorders affecting the β-globin gene, resulting in the polymerization of hemoglobin and subsequent sickling of the red blood cell. Renal disease, the most common complication in SCD, begins in childhood with glomerular hyperfiltration and then progresses into albuminuria, a fast decline of glomerular filtration, and renal failure in adults. This mini-review focuses on glomerular filtration abnormalities and the mechanisms of hyperfiltration, explores genetic modifiers and methods of estimating glomerular filtration rates, and examines novel biomarkers of glomerular filtration in SCD.
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Affiliation(s)
- Nowah Afangbedji
- Department of Physiology and Biophysics, Howard University, Washington, DC, United States
| | - Marina Jerebtsova
- Department of Microbiology, Howard University, Washington, DC, United States
- *Correspondence: Marina Jerebtsova,
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12
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Longitudinal Study of Glomerular Hyperfiltration in Adults with Sickle Cell Anemia: A Multicenter Pooled Analysis. Blood Adv 2022; 6:4461-4470. [PMID: 35696734 PMCID: PMC9636315 DOI: 10.1182/bloodadvances.2022007693] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 06/07/2022] [Indexed: 11/21/2022] Open
Abstract
Glomerular hyperfiltration is common in young sickle cell anemia patients and precedes development of overt kidney disease. In this multicenter pooled cohort, we characterized hyperfiltration and its decline to normal range in adult patients. Glomerular filtration rate (GFR) was estimated using the creatinine-based 2009 CKD-EPI (Chronic Kidney Disease Epidemiology Collaboration) equation omitting race adjustment and the 2021 CKD-EPI equation. Using CKD-EPI–2009, 506 patients had baseline estimated GFR (eGFR) ≥90 mL/min per 1.73 m2, median age of 24 (interquartile range [IQR], 19-34) years and 5.17 years of follow-up. The prevalence of hyperfiltration (eGFR ≥140 and ≥130 mL/min per 1.73 m2 for men and women, respectively) was 38.3%. Using CKD-EPI–2009, baseline hyperfiltration was less likely with older age (odds ratio [OR], 0.78; 95% confidence interval [CI], 0.73-0.83; P < .0001), male sex (OR, 0.32; 95% CI, 0.18-0.58; P = .0002), and higher weight (OR, 0.96; 95% CI, 0.94-0.99; P = .001). Using CKD-EPI–2021, hyperfiltration was similarly less likely with older age (OR, 0.75; 95% CI, 0.70-0.81; P < .0001), male sex (OR, 0.24; 95% CI, 0.13-0.44; P < .0001), and higher weight (OR, 0.97; 95% CI, 0.95-0.99; P = .004). In patients with baseline hyperfiltration, eGFR declined to normal values at a median age of 26.2 years. Using CKD-EPI–2009, this decline was associated with male sex (HR, 2.20; 95% CI, 1.26-3.87; P = .006), systolic blood pressure (hazard ratio [HR], 1.02; 95% CI, 1.01-1.04; P = .01), and hydroxyurea use (HR, 1.74; 95% CI, 1.002-3.03; P = .05). Using CKD-EPI–2021, decline of eGFR to normal was only associated with male sex (HR, 3.39; 95% CI, 2.01-5.69; P < .0001). Decline to normal eGFR range from hyperfiltration occurs earlier in males, those on hydroxyurea, and with higher systolic blood pressure.
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13
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Ataga KI, Saraf SL, Derebail VK. The nephropathy of sickle cell trait and sickle cell disease. Nat Rev Nephrol 2022; 18:361-377. [PMID: 35190716 PMCID: PMC9832386 DOI: 10.1038/s41581-022-00540-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/19/2022] [Indexed: 01/13/2023]
Abstract
Sickle cell syndromes, including sickle cell disease (SCD) and sickle cell trait, are associated with multiple kidney abnormalities. Young patients with SCD have elevated effective renal plasma flow and glomerular filtration rates, which decrease to normal ranges in young adulthood and subnormal levels with advancing age. The pathophysiology of SCD-related nephropathy is multifactorial - oxidative stress, hyperfiltration and glomerular hypertension are all contributing factors. Albuminuria, which is an early clinical manifestation of glomerular damage, is common in individuals with SCD. Kidney function declines more rapidly in individuals with SCD than in those with sickle cell trait or in healthy individuals. Multiple genetic modifiers, including APOL1, HMOX1, HBA1 and HBA2 variants are also implicated in the development and progression of SCD-related nephropathy. Chronic kidney disease and rapid decline in estimated glomerular filtration rate are associated with increased mortality in adults with SCD. Renin-angiotensin-aldosterone system inhibitors are the standard of care treatment for albuminuria in SCD, despite a lack of controlled studies demonstrating their long-term efficacy. Multiple studies of novel therapeutic agents are ongoing, and patients with SCD and kidney failure should be evaluated for kidney transplantation. Given the high prevalence and severe consequences of kidney disease, additional studies are needed to elucidate the pathophysiology, natural history and treatment of SCD-related nephropathy.
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Affiliation(s)
- Kenneth I Ataga
- Center for Sickle Cell Disease, University of Tennessee Health Scienter Center, Memphis, TN, USA.
| | - Santosh L Saraf
- Division of Hematology/Oncology, University of Illinois, Chicago, IL, USA
| | - Vimal K Derebail
- Division of Nephrology and Hypertension, University of North Carolina, Chapel Hill, NC, USA
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14
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Amarapurkar P, Roberts L, Navarrete J, El Rassi F. Sickle Cell Disease and Kidney. Adv Chronic Kidney Dis 2022; 29:141-148.e1. [PMID: 35817521 DOI: 10.1053/j.ackd.2022.03.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 03/01/2022] [Accepted: 03/10/2022] [Indexed: 11/11/2022]
Abstract
Sickle cell disease causes several kidney manifestations. They include defects in urine concentration, impaired handling of potassium and hydrogen ion, albuminuria, acute kidney injury, and chronic kidney disease to name a few. Glomerular hyperfiltration, tubular hyperfunctioning, endothelial damage from repeated sickling and vaso-occlusive episodes, and iron-induced proinflammatory changes in the glomerular mesangium and tubulointerstitium are some of the mechanisms of kidney damage. Albuminuria is one of the most and common clinical features of kidney disease and progresses with age. Kidney disease in patients with sickle cell is associated with increased mortality. Annual screening for proteinuria starting at age 10 years and limiting the use of nonsteroidal anti-inflammatory agents and the use of angiotensin-converting enzyme inhibitors may help in early detection and delaying the progression of kidney disease. Adequate hydration, angiotensin-converting enzyme inhibitors, and adequate control of sickle cell are the main stay of treatment for albuminuria. The hemoglobin goal for patients with sickle cell nephropathy is lesser (10 g/dL) than that for patients with chronic kidney disease due to other causes given that a higher hemoglobin level increases viscosity and the risk of precipitating vaso-occlusive episodes. A multidisciplinary approach is recommended for managing patients with sickle cell and kidney diseases.
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Affiliation(s)
- Pooja Amarapurkar
- Division of Renal Medicine, Emory University School of Medicine, Atlanta, GA.
| | - Levard Roberts
- Division of Renal Medicine, Emory University School of Medicine, Atlanta, GA
| | - Jose Navarrete
- Division of Renal Medicine, Emory University School of Medicine, Atlanta, GA
| | - Fuad El Rassi
- Associate Professor of Hematology and Medical Oncology, Emory University School of Medicine, Director of Sickle Cell Research, Georgia Comprehensive Sickle Cell Center at Grady Health System, Winship Cancer Institute of Emory University, Atlanta, GA
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15
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Derebail VK, Zhou Q, Ciccone EJ, Cai J, Ataga KI. Longitudinal study of glomerular hyperfiltration and normalization of estimated glomerular filtration in adults with sickle cell disease. Br J Haematol 2021; 195:123-132. [PMID: 34402052 DOI: 10.1111/bjh.17723] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 07/07/2021] [Accepted: 07/09/2021] [Indexed: 01/16/2023]
Abstract
Glomerular hyperfiltration is common in sickle cell disease (SCD) and precedes proteinuria and declining kidney function. We evaluated hyperfiltration in SCD patients and its "normalization." Routine visit data were collected retrospectively from adult SCD patients in a single centre from 2004 to 2013. Baseline was defined as first available serum creatinine and hyperfiltration as estimated glomerular filtration rates (eGFR) >130 ml/min/1·73 m2 for women and >140 ml/min/1·73 m2 for men. Normalization of hyperfiltration was eGFR reduction to 90-130 ml/min/1·73 m2 for women or 90-140 ml/min/1·73 m2 for men. Among 292 patients, median age was 27 years [interquartile range (IQR):20·0-38·0], and 56·8% had baseline hyperfiltration. Baseline hyperfiltration was inversely associated with age [odds ratio (OR):0·86, 95% confidence interval (CI): 0·82-0·90; P < 0·0001], male sex (OR:0·16, 95% CI: 0·07-0·41; P = 0·0001), haemoglobin (OR:0·76, 95% CI 0·61-0·94; P = 0·01), weight (OR:0·96, 95% CI: 0·93-0·99; P = 0·004), and angiotensin-converting enzyme inhibitor/angiotensin receptor blocker (ACE-I/ARB) use (OR:0·08, 95% CI: 0·01-0·75; P = 0·03), and positively with hydroxycarbamide use (OR:2·99, 95% CI: 1·18-7·56; P = 0·02). Of 89 hyperfiltration patients without baseline proteinuria, 10 (11·2%) developed new-onset proteinuria [median 1·05 years (IQR:0·63-2·09)]. Normalization of hyperfiltration was less likely with higher baseline eGFR [hazard ratio (HR):0·90, 95% CI: 0·86-0·95; P < 0·0001] and more likely in males (HR:6·35, 95% CI:2·71-14·86, <0·0001). Hyperfiltration is common in adult SCD patients, particularly when younger. Decline to normal values is more likely in males, possibly representing kidney function loss rather than improvement in hyperfiltration.
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Affiliation(s)
- Vimal K Derebail
- Division of Nephrology and Hypertension, UNC Kidney Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Qingning Zhou
- Department of Mathematics and Statistics, University of North Carolina at Charlotte, Charlotte, NC, USA
| | - Emily J Ciccone
- Division of Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Jianwen Cai
- Department of Biostatistics, University of North Carolina, Chapel Hill, NC, USA
| | - Kenneth I Ataga
- Center for Sickle Cell Disease, University of Tennessee Health Science Center, Memphis, TN, USA
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16
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Ramsay Z, Bartlett R, Ali A, Grant J, Gordon-Strachan G, Asnani M. Sickle Cell Disease and Pain: Is it all Vaso-occlusive Crises? Clin J Pain 2021; 37:583-590. [PMID: 34008506 DOI: 10.1097/ajp.0000000000000949] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 04/12/2021] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Acute pain is the main complication of sickle cell disease. Chronic pain (CP) and neuropathic pain (NP) may also be experienced, but have not been formally described in Jamaican patients. A cross-sectional study was conducted to determine their prevalence and characteristics, and to determine the common pain locations and modalities of management. MATERIALS AND METHODS All well individuals with sickle cell disease patients 14 years and older, not pregnant and without a history of clinical stroke were consecutively recruited. Anthropometric measurements, hematology studies, an analgesia checklist, and the Adult Sickle Cell Quality of Life Measurement Information System questionnaire were completed. The painDETECT questionnaire was completed to describe NP and pain patterns-from which CP was defined. RESULTS There were 257 patients in total, with 55.6% being females; the mean age of the patients was 31.7±12 years, and 75% had the SS genotype. Almost all patients (92.6%) had had an acute pain crisis in their lifetime and 72.4% in the last year. The mean severity at last attack was 6.8±3.1 on a scale of 0 to 10. The prevalences of CP and NP were 21.5% and 17.9%, respectively. Female sex, the presence of current leg ulcers, and the use of a strong opioid in the last 4 weeks produced higher odds of NP, whereas older age, milder genotypes, and daily analgesic use had the highest odds of CP. Opioids were used by 40.1% of the patients in the previous 4 weeks, whereas nonpharmacological treatments such as physiotherapy was less used, but reported to be very effective. DISCUSSION CP and NP should be assessed during routine care of sickle cell pain so that targeted therapies can be applied.
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Affiliation(s)
- Zachary Ramsay
- Sickle Cell Unit, Caribbean Institute for Health Research, The University of the West Indies
| | - Rachel Bartlett
- Sickle Cell Unit, Caribbean Institute for Health Research, The University of the West Indies
| | - Amza Ali
- Department of Medicine, Kingston Public Hospital, Kingston, Jamaica
| | | | | | - Monika Asnani
- Sickle Cell Unit, Caribbean Institute for Health Research, The University of the West Indies
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17
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Remy A, Théorêt Y, Ansari M, Bittencourt H, Ducruet T, Nava T, Pastore Y, Rezgui MA, Krajinovic M, Kleiber N. Is Busulfan Clearance Different in Patients With Sickle Cell Disease? Let's Clear Up That Case With Some Controls. J Pediatr Hematol Oncol 2021; 43:e867-e872. [PMID: 33661168 DOI: 10.1097/mph.0000000000002106] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Accepted: 12/28/2020] [Indexed: 11/26/2022]
Abstract
In busulfan-based conditioning regimen for hematopoietic stem cell transplantation in children, accurate a priori determination of the first dose is important because of its narrow therapeutic window. Sickle cell disease (SCD) influences pharmacokinetics of the commonly used drugs by affecting organs responsible for drug metabolism and elimination. This pharmacokinetics study assesses the influence of SCD on the metabolic pathway of busulfan that is mainly metabolized in the liver. In this retrospective cross-sectional case-control study, 16 patients with SCD were matched to 50 patients without SCD on known busulfan clearance's covariates (glutathione-S-transferase alpha1 polymorphisms, age, weight). Clearance of the first dose of busulfan was not significantly different independently of genetic or anthropometric factors in patients with or without SCD.
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Affiliation(s)
- Amandine Remy
- Department of Pediatric Hematology, Univ. Lille, CHU Lille, Lille, France
- Unité de pharmacologie clinique
| | - Yves Théorêt
- Unité de pharmacologie clinique
- Departments of Pharmacology and Physiology
- Charles-Bruneau Cancer Center, CHU Sainte-Justine Research Center, Université de Montréal
| | - Marc Ansari
- CANSEARCH Research Laboratory, Department of Pediatrics, Gynecology and Obstetrics, University of Geneva
- Department of Women-Children-Adolescents, Division of General Pediatrics, Pediatric Onco-Hematology Unit, Geneva University Hospital, Geneva, Switzerland
| | - Henrique Bittencourt
- Pediatrics
- Charles-Bruneau Cancer Center, CHU Sainte-Justine Research Center, Université de Montréal
| | - Thierry Ducruet
- Applied Clinical Research Unit, CHU Sainte-Justine, Montreal, QC, Canada
| | - Tiago Nava
- CANSEARCH Research Laboratory, Department of Pediatrics, Gynecology and Obstetrics, University of Geneva
- Department of Women-Children-Adolescents, Division of General Pediatrics, Pediatric Onco-Hematology Unit, Geneva University Hospital, Geneva, Switzerland
| | - Yves Pastore
- Pediatrics
- Charles-Bruneau Cancer Center, CHU Sainte-Justine Research Center, Université de Montréal
| | - Mohamed A Rezgui
- Charles-Bruneau Cancer Center, CHU Sainte-Justine Research Center, Université de Montréal
| | - Maja Krajinovic
- Departments of Pharmacology and Physiology
- Pediatrics
- Charles-Bruneau Cancer Center, CHU Sainte-Justine Research Center, Université de Montréal
| | - Niina Kleiber
- Departments of Pharmacology and Physiology
- Pediatrics
- Research Center, CHU Sainte-Justine
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18
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Boudhabhay I, Boutin E, Bartolucci P, Bornes MI, Habibi A, Lionnet F, Hertig A, Grimbert P, Stehlé T, El Karoui K, Sahali D, Fois E, Rémy P, Galacteros F, Haddad B, Canoui-Poitrine F, Lecarpentier E, Audard V. Impact of pre-eclampsia on renal outcome in sickle cell disease patients. Br J Haematol 2021; 194:1053-1062. [PMID: 34131893 DOI: 10.1111/bjh.17606] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 04/06/2021] [Indexed: 12/31/2022]
Abstract
The long-term consequences of pre-eclampsia (PrE) for renal function have never been determined in patients with sickle cell disease (SCD). Between 2008 and 2015, we screened 306 pregnancies in women with SCD and identified 40 with PrE (13%). The control group consisted of 65 pregnant SCD patients without PrE. In multivariable analysis, PrE events were associated with an increase of 1 log of lactate dehydrogenase level (adjusted odds ratio, aOR = 3·83, P = 0·05), a decrease of 10 g/l of haemoglobin levels (aOR = 2·48, P = 0·006) and one or more vaso-occlusive crisis during pregnancy (aOR = 16·68, P = 0·002). Estimated glomerular filtration rate (eGFR) was similar in the two groups at steady state but was significantly lower in the PrE group after one year of follow-up and at last follow-up (130 vs 148 ml/min/1·73 m2 , P < 0·001 and 120 vs 130 ml/min/1·73 m2 , P < 0·001, respectively). In multivariable analysis, eGFR had returned to steady-state levels one year after pregnancy in patients without PrE but continued to decrease in patients with PrE (β = -18·15 ml/min/1·73 m2 , P < 0·001). This decline was more marked at the end of follow-up (β = -31·15 ml/min, P < 0·001). In conclusion, PrE episodes are associated with a significant risk of subsequent renal function decline in SCD patients.
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Affiliation(s)
- Idris Boudhabhay
- Service de Néphrologie et Transplantation, Centre de Référence Maladie Rare Syndrome Néphrotique Idiopathique, Fédération Hospitalo-Universitaire Innovative Therapy for Immune Disorders, Assistance Publique des Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Henri Mondor, Créteil, France.,Univ Paris Est Créteil, Institut National de la Santé et de la Recherche Médicale (INSERM) U955, Equipe 21, Institut Mondor de Recherche Biomédicale (IMRB), Créteil, France
| | - Emmanuelle Boutin
- Unité de Recherche Clinique (URC Mondor), Assistance Publique des Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Henri Mondor, Créteil, France.,Service de Santé Publique, Assistance Publique Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Henri Mondor, Créteil, France.,Univ Paris Est Creteil, INSERM, IMRB, Equipe CEpiA (Clinical Epidemiology and Ageing), Créteil, France
| | - Pablo Bartolucci
- Centre de Référence des Syndromes Drépanocytaires Majeurs, Assistance Publique des Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Henri Mondor, Créteil, France.,Univ Paris Est Créteil, Département Hospitalo-Universitaire Ageing-Thorax-Vessels-Blood, INSERM, IMRB, Equipe 2, Laboratoire d'excellence GRex, Créteil, France
| | - Marie-Isabelle Bornes
- Service de Gynécologie-Obstétrique et Médecine de la Reproduction, Assistance Publique des Hôpitaux de Paris (AP-HP), Hôpital Tenon, Paris, France
| | - Anoosha Habibi
- Centre de Référence des Syndromes Drépanocytaires Majeurs, Assistance Publique des Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Henri Mondor, Créteil, France.,Univ Paris Est Créteil, Département Hospitalo-Universitaire Ageing-Thorax-Vessels-Blood, INSERM, IMRB, Equipe 2, Laboratoire d'excellence GRex, Créteil, France
| | - François Lionnet
- Service de Médecine Interne, Centre de Référence des Syndromes Drépanocytaires Majeurs, Assistance Publique des Hôpitaux de Paris (AP-HP), Hôpital Tenon, Sorbonne Université, Paris, France
| | - Alexandre Hertig
- Service de Transplantation Rénale, Assistance Publique des Hôpitaux de Paris (AP-HP), Hôpital de la Pitié Salpétrière, Sorbonne Université, Paris, France
| | - Philippe Grimbert
- Service de Néphrologie et Transplantation, Centre de Référence Maladie Rare Syndrome Néphrotique Idiopathique, Fédération Hospitalo-Universitaire Innovative Therapy for Immune Disorders, Assistance Publique des Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Henri Mondor, Créteil, France.,Univ Paris Est Créteil, Institut National de la Santé et de la Recherche Médicale (INSERM) U955, Equipe 21, Institut Mondor de Recherche Biomédicale (IMRB), Créteil, France
| | - Thomas Stehlé
- Service de Néphrologie et Transplantation, Centre de Référence Maladie Rare Syndrome Néphrotique Idiopathique, Fédération Hospitalo-Universitaire Innovative Therapy for Immune Disorders, Assistance Publique des Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Henri Mondor, Créteil, France.,Univ Paris Est Créteil, Institut National de la Santé et de la Recherche Médicale (INSERM) U955, Equipe 21, Institut Mondor de Recherche Biomédicale (IMRB), Créteil, France
| | - Khalil El Karoui
- Service de Néphrologie et Transplantation, Centre de Référence Maladie Rare Syndrome Néphrotique Idiopathique, Fédération Hospitalo-Universitaire Innovative Therapy for Immune Disorders, Assistance Publique des Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Henri Mondor, Créteil, France.,Univ Paris Est Créteil, Institut National de la Santé et de la Recherche Médicale (INSERM) U955, Equipe 21, Institut Mondor de Recherche Biomédicale (IMRB), Créteil, France
| | - Dil Sahali
- Service de Néphrologie et Transplantation, Centre de Référence Maladie Rare Syndrome Néphrotique Idiopathique, Fédération Hospitalo-Universitaire Innovative Therapy for Immune Disorders, Assistance Publique des Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Henri Mondor, Créteil, France.,Univ Paris Est Créteil, Institut National de la Santé et de la Recherche Médicale (INSERM) U955, Equipe 21, Institut Mondor de Recherche Biomédicale (IMRB), Créteil, France
| | - Elena Fois
- Centre de Référence des Syndromes Drépanocytaires Majeurs, Assistance Publique des Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Henri Mondor, Créteil, France.,Univ Paris Est Créteil, Département Hospitalo-Universitaire Ageing-Thorax-Vessels-Blood, INSERM, IMRB, Equipe 2, Laboratoire d'excellence GRex, Créteil, France
| | - Philippe Rémy
- Service de Néphrologie et Transplantation, Centre de Référence Maladie Rare Syndrome Néphrotique Idiopathique, Fédération Hospitalo-Universitaire Innovative Therapy for Immune Disorders, Assistance Publique des Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Henri Mondor, Créteil, France.,Univ Paris Est Créteil, Institut National de la Santé et de la Recherche Médicale (INSERM) U955, Equipe 21, Institut Mondor de Recherche Biomédicale (IMRB), Créteil, France
| | - Frédéric Galacteros
- Centre de Référence des Syndromes Drépanocytaires Majeurs, Assistance Publique des Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Henri Mondor, Créteil, France.,Univ Paris Est Créteil, Département Hospitalo-Universitaire Ageing-Thorax-Vessels-Blood, INSERM, IMRB, Equipe 2, Laboratoire d'excellence GRex, Créteil, France
| | - Bassam Haddad
- Centre Hospitalier Inter-Communal de Créteil, Service de Gynécologie-Obstétrique et Médecine de la Reproduction, Equipe Immunorégulation et Biothérapie (I-BIOT), Université Paris Est Créteil, Univ Paris Est Créteil, Institut National de la Santé et de la Recherche Médicale (INSERM) U955, Institut Mondor De Recherche Biomédicale (IMRB), Créteil, France
| | - Florence Canoui-Poitrine
- Unité de Recherche Clinique (URC Mondor), Assistance Publique des Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Henri Mondor, Créteil, France.,Service de Santé Publique, Assistance Publique Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Henri Mondor, Créteil, France.,Univ Paris Est Creteil, INSERM, IMRB, Equipe CEpiA (Clinical Epidemiology and Ageing), Créteil, France
| | - Edouard Lecarpentier
- Centre Hospitalier Inter-Communal de Créteil, Service de Gynécologie-Obstétrique et Médecine de la Reproduction, Equipe Immunorégulation et Biothérapie (I-BIOT), Université Paris Est Créteil, Univ Paris Est Créteil, Institut National de la Santé et de la Recherche Médicale (INSERM) U955, Institut Mondor De Recherche Biomédicale (IMRB), Créteil, France
| | - Vincent Audard
- Service de Néphrologie et Transplantation, Centre de Référence Maladie Rare Syndrome Néphrotique Idiopathique, Fédération Hospitalo-Universitaire Innovative Therapy for Immune Disorders, Assistance Publique des Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Henri Mondor, Créteil, France.,Univ Paris Est Créteil, Institut National de la Santé et de la Recherche Médicale (INSERM) U955, Equipe 21, Institut Mondor de Recherche Biomédicale (IMRB), Créteil, France
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19
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Ataga KI, Zhou Q, Derebail VK, Saraf SL, Hankins JS, Loehr LR, Garrett ME, Ashley-Koch AE, Cai J, Telen MJ. Rapid decline in estimated glomerular filtration rate in sickle cell anemia: results of a multicenter pooled analysis. Haematologica 2021; 106:1749-1753. [PMID: 33179474 PMCID: PMC8168505 DOI: 10.3324/haematol.2020.267419] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Indexed: 01/10/2023] Open
Abstract
Not available.
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Affiliation(s)
- Kenneth I Ataga
- Center for Sickle Cell Disease, University of Tennessee Health Scienter Center, Memphis, TN.
| | - Qingning Zhou
- Department of Mathematics and Statistics, University of North Carolina, Charlotte
| | - Vimal K Derebail
- Division of Nephrology and Hypertension, University of North Carolina, Chapel Hill
| | - Santosh L Saraf
- Division of Hematology/Oncology, University of Illinois, Chicago, IL
| | - Jane S Hankins
- Department of Hematology, St. Jude Children's Research Hospital, Memphis, TN
| | - Laura R Loehr
- Division of General Medicine and Clinical Epidemiology, University of North Carolina, Chapel Hill
| | - Melanie E Garrett
- Duke Molecular Physiology Institute, Duke University Medical Center, Durham
| | | | - Jianwen Cai
- Department of Biostatistics, University of North Carolina, Chapel Hill
| | - Marilyn J Telen
- Division of Hematology, Duke University Medical Center, Durham
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20
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Progression of albuminuria in patients with sickle cell anemia: a multicenter, longitudinal study. Blood Adv 2021; 4:1501-1511. [PMID: 32289161 DOI: 10.1182/bloodadvances.2019001378] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Accepted: 03/16/2020] [Indexed: 12/28/2022] Open
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.
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21
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Güntürkün F, Chen D, Akbilgic O, Davis RL, Karabayir I, Strome M, Dai Y, Saraf SL, Ataga KI. Using machine learning to predict rapid decline of kidney function in sickle cell anemia. EJHAEM 2021; 2:257-260. [PMID: 35845269 PMCID: PMC9176130 DOI: 10.1002/jha2.168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 01/17/2021] [Indexed: 11/11/2022]
Affiliation(s)
- Fatma Güntürkün
- Center for Biomedical InformaticsUniversity of Tennessee Health Science CenterMemphisUSA
| | - Daiqing Chen
- Department of BioengineeringUniversity of Illinois at ChicagoChicagoUSA
| | - Oguz Akbilgic
- Department of Health Informatics and Data ScienceLoyola University ChicagoMaywoodUSA
| | - Robert L. Davis
- Center for Biomedical InformaticsUniversity of Tennessee Health Science CenterMemphisUSA
| | - Ibrahim Karabayir
- Department of Health Informatics and Data ScienceLoyola University ChicagoMaywoodUSA
- Department of EconometricsKirklareli UniversityKirklareliTurkey
| | - Maxwell Strome
- Department of Computer ScienceUniversity of MichiganAnn ArborUSA
| | - Yang Dai
- Department of BioengineeringUniversity of Illinois at ChicagoChicagoUSA
| | - Santosh L. Saraf
- Department of MedicineUniversity of Illinois at ChicagoChicagoUSA
| | - Kenneth I. Ataga
- Center for Sickle Cell DiseaseUniversity of Tennessee Health Science CenterMemphisUSA
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22
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Automated Red Cell Exchange in the Management of Sickle Cell Disease. J Clin Med 2021; 10:jcm10040767. [PMID: 33671876 PMCID: PMC7918980 DOI: 10.3390/jcm10040767] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 02/09/2021] [Accepted: 02/10/2021] [Indexed: 01/24/2023] Open
Abstract
Red cell transfusion represents one of the cornerstones of the chronic management of sickle cell disease, as well as its acute complications. Automated red cell exchange can rapidly lower the number of circulating sickle erythrocytes, without causing iron overload. Here, we describe our experience, having offered this intervention since 2011. A transient reduction in the platelet count by 61% was observed after the procedure. This was not associated with any haemorrhagic complications. Despite exposure to large volumes of blood, the alloimmunisation rate was only 0.027/100 units of red cells. The absence of any iron loading was confirmed by serial Ferriscans, performed over a number of years. However, patients with advanced chronic kidney disease showed evidence of iron loading due to reduced innate haemopoiesis and were subsequently switched to simple transfusions. A total of 59% of patients were on regular automated red cell exchange with a history of recurrent painful crises. A total of 77% responded clinically, as evidenced by at least a 25% reduction in their emergency hospital attendance for pain management. The clinical response was gradual and increased the longer patients stayed on the program. The earliest sign of clinical response was a reduction in the length of stay when these patients were hospitalised, indicating that a reduction in the severity of crises precedes the reduction in their frequency. Automated red cell exchange also appeared to be beneficial for patients with recurrent leg ulcers and severe, drug resistant stuttering priapism, while patients with pulmonary hypertension showed a dramatic improvement in their symptoms as well as echocardiographic parameters.
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Olaniran KO, Eneanya ND, Zhao SH, Ofsthun NJ, Maddux FW, Thadhani RI, Dalrymple LS, Nigwekar SU. Mortality and Hospitalizations among Sickle Cell Disease Patients with End-Stage Kidney Disease Initiating Dialysis. Am J Nephrol 2021; 51:995-1003. [PMID: 33486484 DOI: 10.1159/000513012] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 11/10/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Sickle cell disease (SCD) is the most common inherited hematological disorder and a well-described risk factor for end-stage kidney disease (ESKD). Mortality and hospitalizations among patients with SCD who develop ESKD remain understudied. Furthermore, prior studies focused only on SCD patients where ESKD was caused by SCD. We aimed to describe mortality and hospitalization risk in all SCD patients initiating dialysis and explore risk factors for mortality and hospitalization. METHODS We performed a national observational cohort study of African American ESKD patients initiating dialysis (2000-2014) in facilities affiliated with a large dialysis provider. SCD was identified by diagnosis codes and matched to a reference population (non-SCD) by age, sex, dialysis initiation year, and geographic region of care. Sensitivity analyses were conducted by restricting to patients where SCD was recorded as the cause of ESKD. RESULTS We identified 504 SCD patients (mean age: 47 ± 14 years; 48% females) and 1,425 reference patients (mean age: 46 ± 14 years; 49% females). The median follow-up was 2.4 (IQR 1.0-4.5) years. Compared to the reference, SCD was associated with higher mortality risk (hazard ratio 1.66; 95% confidence interval [CI]: 1.36-2.03) and higher hospitalization rates (incidence rate ratio 2.12; 95% CI: 1.88-2.38) in multivariable analyses. Exploratory multivariable mortality risk models showed the largest mortality risk attenuation with the addition of time-varying hemoglobin and high-dose erythropoietin, but the association of SCD with mortality remained significant. Sensitivity analyses (restricted to ESKD caused by SCD) also showed significant associations between SCD and mortality and hospitalizations, but with larger effect estimates. High-dose erythropoietin was associated with the highest risk for mortality and hospitalization in SCD. CONCLUSIONS Among ESKD patients, SCD is associated with a higher risk for mortality and hospitalization, particularly in patients where SCD is identified as the cause of ESKD.
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Affiliation(s)
- Kabir O Olaniran
- Division of Nephrology, Department of Medicine, University of Texas Southwestern, Dallas, Texas, USA,
| | - Nwamaka D Eneanya
- Renal-Electrolyte and Hypertension Division, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Sophia H Zhao
- Division of Nephrology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Norma J Ofsthun
- Fresenius Medical Care North America, Waltham, Massachusetts, USA
| | - Franklin W Maddux
- Fresenius Medical Care North America, Waltham, Massachusetts, USA
- Fresenius Medical Care AG & Co, KGaA, Bad Homburg, Germany
| | - Ravi I Thadhani
- Division of Nephrology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Mass General Brigham, Boston, Massachusetts, USA
| | | | - Sagar U Nigwekar
- Division of Nephrology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
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Pressiat C, Rakotoson MG, Habibi A, Barau C, Arrouasse R, Galactéros F, Stehlé T, Audard V, Hulin A, Bartolucci P. Impact of renal function on hydroxyurea exposure in sickle-cell disease patients. Br J Clin Pharmacol 2020; 87:2274-2285. [PMID: 33217005 DOI: 10.1111/bcp.14653] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 09/24/2020] [Accepted: 10/13/2020] [Indexed: 12/17/2022] Open
Abstract
AIMS This prospective study aimed to develop a population pharmacokinetics (PK) model of hydroxyurea (HU) in patients with sickle cell disease. This model can be used to determine the impact of glomerular filtration rate (GFR) on HU kinetics. METHODS We included 30 patients. They underwent HU pharmacokinetics analyses of plasma and urine. Six underwent PK analyses in 2 periods with and without angiotensin-converting enzyme inhibitor. HU was assayed with a validated high-performance liquid chromatography-UV method. Noncompartmental PK analysis was conducted and a population PK model built with Monolix. This model was validated externally on another 56 patients. HU PK was simulated as a function of GFR. RESULTS The HU PK model was constructed as a 2-compartment model with first-order absorption and elimination. The quality criteria were good, including for external validation. We found that estimated GFR (eGFR) and body weight affected HU PK, with lower eGFR or body weight associated with a higher HU area under the curve. We recommend the monitoring of HU through eGFR and body weight, which together account for 47% of its variability. Urinary HU fractions and renal clearance were higher in the glomerular hyperfiltration group and lower in the moderate chronic kidney disease group, respectively. No differences in nonrenal HU clearance were observed. CONCLUSION Estimated GFR has an impact on the kinetics of hydroxyurea, and HU dose should be adapted accordingly. Angiotensin-converting enzyme inhibitor seems to have minor effect on HU PK in adults with sickle cell disease.
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Affiliation(s)
- Claire Pressiat
- Laboratoire de Pharmacologie, Assistance Publique des Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Henri Mondor, Université Paris Est-Créteil, Créteil, France
| | - Marie-Georgine Rakotoson
- Centre de référence pour les syndromes drépanocytaires majeurs, AP-HP, Hôpitaux Universitaires Henri Mondor, Université Paris Est-Créteil, Créteil, France.,Filière MCGRE. DHU A TVB. Institut Mondor de Recherche Biomédicale (IMRB) équipe 2. Laboratoire d'excellence GRex, Université Paris Est-Créteil, Créteil, France
| | - Anoosha Habibi
- Centre de référence pour les syndromes drépanocytaires majeurs, AP-HP, Hôpitaux Universitaires Henri Mondor, Université Paris Est-Créteil, Créteil, France
| | - Caroline Barau
- Plate-forme de Ressources Biologiques, AP-HP, Hôpitaux Universitaires Henri Mondor, Université Paris Est-Créteil, Créteil, France
| | - Raphaele Arrouasse
- Institut National de la Santé et de la Recherche Médicale (INSERM), Centre Investigations Cliniques 1430, AP-HP, Hôpitaux Universitaires Henri Mondor, Université Paris Est-Créteil, Créteil, France
| | - Frédéric Galactéros
- Centre de référence pour les syndromes drépanocytaires majeurs, AP-HP, Hôpitaux Universitaires Henri Mondor, Université Paris Est-Créteil, Créteil, France
| | - Thomas Stehlé
- Service de Néphrologie et Transplantation, AP-HP, Hôpitaux Universitaires Henri Mondor, Créteil, France.,Inserm U955, équipe 21, IMRB, Université Paris Est-Créteil, Créteil, France
| | - Vincent Audard
- Service de Néphrologie et Transplantation, AP-HP, Hôpitaux Universitaires Henri Mondor, Créteil, France.,Inserm U955, équipe 21, IMRB, Université Paris Est-Créteil, Créteil, France
| | - Anne Hulin
- Laboratoire de Pharmacologie, Assistance Publique des Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Henri Mondor, Université Paris Est-Créteil, Créteil, France
| | - Pablo Bartolucci
- Centre de référence pour les syndromes drépanocytaires majeurs, AP-HP, Hôpitaux Universitaires Henri Mondor, Université Paris Est-Créteil, Créteil, France.,Filière MCGRE. DHU A TVB. Institut Mondor de Recherche Biomédicale (IMRB) équipe 2. Laboratoire d'excellence GRex, Université Paris Est-Créteil, Créteil, France
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25
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Sex differences in the trajectory of glomerular filtration rate in pediatric and murine sickle cell anemia. Blood Adv 2020; 4:263-265. [PMID: 31951651 DOI: 10.1182/bloodadvances.2019001237] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Accepted: 12/09/2019] [Indexed: 01/04/2023] Open
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26
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Outcomes following kidney transplantation in patients with sickle cell disease: The impact of automated exchange blood transfusion. PLoS One 2020; 15:e0236998. [PMID: 32790687 PMCID: PMC7425908 DOI: 10.1371/journal.pone.0236998] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Accepted: 07/18/2020] [Indexed: 11/19/2022] Open
Abstract
There are over 12,000 people with sickle cell disease (SCD) in the UK, and 4-12% of patients who develop Sickle Cell Nephropathy (SCN) progress to End Stage Renal Disease (ESRD). Renal transplantation offers the best outcomes for these patients with but their access to transplantation is often limited. Regular automated exchange blood transfusions (EBT) reduce the complications of SCD and may improve outcomes. However, concerns over alloimmunisation limit its widespread implementation. In this retrospective multicenter study, data were collected on 34 SCD patients who received a kidney transplant across 6 London Hospitals between 1997 and 2017. 20/34 patients were on an EBT program, pre or post renal transplantation. Overall patient and graft survival were inferior to contemporaneous UK data in the ESRD population as a whole, a finding which is well-recognised. However, patient survival (CI 95%, p = 0.0032), graft survival and graft function were superior at all time-points in those who received EBT versus those who did not. 4/20 patients (20%) on EBT developed de novo donor specific antibodies (DSAs). 3/14 patients (21%) not on EBT developed de novo DSAs. The incidence of rejection in those on EBT was 5/18 (28%), as compared with 7/13 (54%) not on EBT. In conclusion, our data, while limited by an inevitably small sample size and differences in the date of transplantation, do suggest that long-term automated EBT post renal transplant is effective and safe, with improvement in graft and patient outcomes and no increase in antibody formation or graft rejection.
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27
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Olaniran KO, Allegretti AS, Zhao SH, Achebe MM, Eneanya ND, Thadhani RI, Nigwekar SU, Kalim S. Kidney Function Decline among Black Patients with Sickle Cell Trait and Sickle Cell Disease: An Observational Cohort Study. J Am Soc Nephrol 2020; 31:393-404. [PMID: 31810990 PMCID: PMC7003305 DOI: 10.1681/asn.2019050502] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Accepted: 10/27/2019] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Sickle cell trait and sickle cell disease are thought to be independent risk factors for CKD, but the trajectory and predictors of kidney function decline in patients with these phenotypes are not well understood. METHODS Our multicenter, observational study used registry data (collected January 2005 through June 2018) and included adult black patients with sickle cell trait or disease (exposures) or normal hemoglobin phenotype (reference) status (ascertained by electrophoresis) and at least 1 year of follow-up and three eGFR values. We used linear mixed models to evaluate the difference in the mean change in eGFR per year. RESULTS We identified 1251 patients with sickle cell trait, 230 with sickle cell disease, and 8729 reference patients, with a median follow-up of 8 years. After adjustment, eGFR declined significantly faster in patients with sickle cell trait or sickle cell disease compared with reference patients; it also declined significantly faster in patients with sickle cell disease than in patients with sickle cell trait. Male sex, diabetes mellitus, and baseline eGFR ≥90 ml/min per 1.73 m2 were associated with faster eGFR decline for both phenotypes. In sickle cell trait, low hemoglobin S and elevated hemoglobin A were associated with faster eGFR decline, but elevated hemoglobins F and A2 were renoprotective. CONCLUSIONS Sickle cell trait and disease are associated with faster eGFR decline in black patients, with faster decline in sickle cell disease. Low hemoglobin S was associated with faster eGFR decline in sickle cell trait but may be confounded by concurrent hemoglobinopathies. Prospective and mechanistic studies are needed to develop best practices to attenuate eGFR decline in such patients.
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Affiliation(s)
- Kabir O Olaniran
- Division of Nephrology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts;
- Division of Nephrology, Department of Internal Medicine, University of Texas Southwestern, Dallas, Texas
| | - Andrew S Allegretti
- Division of Nephrology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Sophia H Zhao
- Division of Nephrology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Maureen M Achebe
- Hematology Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Nwamaka D Eneanya
- Renal-Electrolyte and Hypertension Division, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; and
| | - Ravi I Thadhani
- Division of Nephrology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
- Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, California
| | - Sagar U Nigwekar
- Division of Nephrology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Sahir Kalim
- Division of Nephrology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
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28
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Cazenave M, Audard V, Bertocchio JP, Habibi A, Baron S, Prot-Bertoye C, Berkenou J, Maruani G, Stehlé T, Cornière N, Ayari H, Friedlander G, Galacteros F, Houillier P, Bartolucci P, Courbebaisse M. Tubular Acidification Defect in Adults with Sickle Cell Disease. Clin J Am Soc Nephrol 2020; 15:16-24. [PMID: 31822527 PMCID: PMC6946065 DOI: 10.2215/cjn.07830719] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Accepted: 10/29/2019] [Indexed: 12/28/2022]
Abstract
BACKGROUND AND OBJECTIVES Metabolic acidosis is a frequent manifestation of sickle cell disease but the mechanisms and determinants of this disorder are unknown. Our aim was to characterize urinary acidification capacity in adults with sickle cell disease and to identify potential factors associated with decreased capacity to acidify urine. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS Among 25 adults with sickle cell disease and an eGFR of ≥60 ml/min per 1.73 m2 from a single center in France, we performed an acute acidification test after simultaneous administration of furosemide and fludrocortisone. A normal response was defined as a decrease in urinary pH <5.3 and an increase in urinary ammonium excretion ≥33 µEq/min at one or more of the six time points after furosemide and fludrocortisone administration. RESULTS Of the participants (median [interquartile range] age of 36 [24-43] years old, 17 women), 12 had a normal and 13 had an abnormal response to the test. Among these 13 participants, nine had normal baseline plasma bicarbonate concentration. Plasma aldosterone was within the normal range for all 13 participants with an abnormal response, making the diagnosis of type 4 tubular acidosis unlikely. The participants with an abnormal response to the test were significantly older, more frequently treated with oral bicarbonate, had a higher plasma uric acid concentration, higher hemolysis activity, lower eGFR, lower baseline plasma bicarbonate concentration, higher urine pH, lower urine ammonium ion excretion, and lower fasting urine osmolality than those with a normal response. Considering both groups, the maximum urinary ammonium ion excretion was positively correlated with fasting urine osmolality (r 2=0.34, P=0.002), suggesting that participants with sickle cell disease and lower urine concentration capacity have lower urine acidification capacity. CONCLUSIONS Among adults with sickle cell disease, impaired urinary acidification capacity attributable to distal tubular dysfunction is common and associated with the severity of hyposthenuria. PODCAST This article contains a podcast at https://www.asn-online.org/media/podcast/CJASN/2019_12_10_CJN07830719.mp3.
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Affiliation(s)
- Maud Cazenave
- Nephrology and Renal Transplantation Department, Pitié-Salpetrière Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Sorbonne University, Paris, France
| | - Vincent Audard
- Nephrology and Renal Transplantation Department, Institut National de la Santé et de la Recherche Médicale (INSERM) U955, Henri Mondor Hospital, AP-HP, Paris Est Créteil University, Créteil, France
| | - Jean-Philippe Bertocchio
- Physiology Department, European Georges Pompidou University Hospital, AP-HP, Paris Descartes University, INSERM U1138, Centre National de la Recherche Scientifique (CNRS) ERL8228, Paris, France
| | - Anoosha Habibi
- Sickle Cell Referral Center, Internal Medicine Unit, IMRB team 2, UPEC, Labex GRex, Henri Mondor Hospital, AP-HP, Créteil, France
| | - Stéphanie Baron
- Physiology Department, European Georges Pompidou University Hospital, AP-HP, Paris Descartes University, INSERM U1138, Centre National de la Recherche Scientifique (CNRS) ERL8228, Paris, France
| | - Caroline Prot-Bertoye
- Physiology Department, European Georges Pompidou University Hospital, AP-HP, Paris Descartes University, INSERM U1138, Centre National de la Recherche Scientifique (CNRS) ERL8228, Paris, France
| | - Jugurtha Berkenou
- Sickle Cell Referral Center, Internal Medicine Unit, IMRB team 2, UPEC, Labex GRex, Henri Mondor Hospital, AP-HP, Créteil, France
| | - Gérard Maruani
- Physiology Department, European Georges Pompidou University Hospital, AP-HP, Paris Descartes University, Necker-Enfants Malades Institute, INSERM U1151-CNRS UMR8253, Paris, France; and
| | - Thomas Stehlé
- Nephrology and Renal Transplantation Department, Institut National de la Santé et de la Recherche Médicale (INSERM) U955, Henri Mondor Hospital, AP-HP, Paris Est Créteil University, Créteil, France
| | - Nicolas Cornière
- Nephrology Department, Felix Guyon Hospital, Saint-Denis, Réunion Island, France
| | - Hamza Ayari
- Physiology Department, European Georges Pompidou University Hospital, AP-HP, Paris Descartes University, INSERM U1138, Centre National de la Recherche Scientifique (CNRS) ERL8228, Paris, France
| | - Gérard Friedlander
- Physiology Department, European Georges Pompidou University Hospital, AP-HP, Paris Descartes University, Necker-Enfants Malades Institute, INSERM U1151-CNRS UMR8253, Paris, France; and
| | - Frédéric Galacteros
- Sickle Cell Referral Center, Internal Medicine Unit, IMRB team 2, UPEC, Labex GRex, Henri Mondor Hospital, AP-HP, Créteil, France
| | - Pascal Houillier
- Physiology Department, European Georges Pompidou University Hospital, AP-HP, Paris Descartes University, INSERM U1138, Centre National de la Recherche Scientifique (CNRS) ERL8228, Paris, France
| | - Pablo Bartolucci
- Sickle Cell Referral Center, Internal Medicine Unit, IMRB team 2, UPEC, Labex GRex, Henri Mondor Hospital, AP-HP, Créteil, France
| | - Marie Courbebaisse
- Physiology Department, European Georges Pompidou University Hospital, AP-HP, Paris Descartes University, Necker-Enfants Malades Institute, INSERM U1151-CNRS UMR8253, Paris, France; and
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29
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Liem RI, Lanzkron S, D Coates T, DeCastro L, Desai AA, Ataga KI, Cohen RT, Haynes J, Osunkwo I, Lebensburger JD, Lash JP, Wun T, Verhovsek M, Ontala E, Blaylark R, Alahdab F, Katabi A, Mustafa RA. American Society of Hematology 2019 guidelines for sickle cell disease: cardiopulmonary and kidney disease. Blood Adv 2019; 3:3867-3897. [PMID: 31794601 PMCID: PMC6963257 DOI: 10.1182/bloodadvances.2019000916] [Citation(s) in RCA: 88] [Impact Index Per Article: 17.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Accepted: 11/01/2019] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Prevention and management of end-organ disease represent major challenges facing providers of children and adults with sickle cell disease (SCD). Uncertainty and variability in the screening, diagnosis, and management of cardiopulmonary and renal complications in SCD lead to varying outcomes for affected individuals. OBJECTIVE These evidence-based guidelines of the American Society of Hematology (ASH) are intended to support patients, clinicians, and other health care professionals in their decisions about screening, diagnosis, and management of cardiopulmonary and renal complications of SCD. METHODS ASH formed a multidisciplinary guideline panel that included 2 patient representatives and was balanced to minimize potential bias from conflicts of interest. The Mayo Evidence-Based Practice Research Program supported the guideline development process, including performing systematic evidence reviews up to September 2017. The panel prioritized clinical questions and outcomes according to their importance for clinicians and patients. The panel used the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach, including GRADE evidence-to-decision frameworks, to assess evidence and make recommendations, which were subject to public comment. RESULTS The panel agreed on 10 recommendations for screening, diagnosis, and management of cardiopulmonary and renal complications of SCD. Recommendations related to anticoagulation duration for adults with SCD and venous thromboembolism were also developed. CONCLUSIONS Most recommendations were conditional due to a paucity of direct, high-quality evidence for outcomes of interest. Future research was identified, including the need for prospective studies to better understand the natural history of cardiopulmonary and renal disease, their relationship to patient-important outcomes, and optimal management.
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Affiliation(s)
- Robert I Liem
- Division of Hematology, Oncology and Stem Cell Transplant, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL
- Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Sophie Lanzkron
- Division of Adult Hematology, School of Medicine, Johns Hopkins University, Baltimore, MD
| | - Thomas D Coates
- Division of Hematology, Oncology and Blood and Marrow Transplantation, Children's Hospital of Los Angeles, Los Angeles, CA
| | - Laura DeCastro
- Division of Hematology/Oncology, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Ankit A Desai
- Krannert Institute of Cardiology, School of Medicine, Indiana University, Indianapolis, IN
| | - Kenneth I Ataga
- Center for Sickle Cell Disease, University of Tennessee Health Science Center, Memphis, TN
| | - Robyn T Cohen
- Division of Pediatric Pulmonary and Allergy, Boston Medical Center, School of Medicine, Boston University, Boston, MA
| | - Johnson Haynes
- Division of Pulmonary Disease, College of Medicine, University of South Alabama, Mobile, AL
| | - Ifeyinwa Osunkwo
- Division of Hematology, The Levine Cancer Institute, Atrium Health, Charlotte, NC
| | - Jeffrey D Lebensburger
- Division of Pediatric Hematology/Oncology, School of Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - James P Lash
- Division of Nephrology, Department of Medicine, University of Illinois at Chicago, Chicago, IL
| | - Theodore Wun
- Division of Hematology and Oncology, School of Medicine, University of California Davis, Sacramento, CA
| | - Madeleine Verhovsek
- Division of Hematology and Thromboembolism, McMaster University, Hamilton, ON, Canada
| | | | | | - Fares Alahdab
- Division of General Internal Medicine, Mayo Medical School, Rochester, MN; and
| | - Abdulrahman Katabi
- Division of General Internal Medicine, Mayo Medical School, Rochester, MN; and
| | - Reem A Mustafa
- Division of Nephrology and Hypertension, School of Medicine, University of Kansas, Kansas City, KS
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30
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Howard J, Thein SL. Optimal disease management and health monitoring in adults with sickle cell disease. HEMATOLOGY. AMERICAN SOCIETY OF HEMATOLOGY. EDUCATION PROGRAM 2019; 2019:505-512. [PMID: 31808832 PMCID: PMC6913450 DOI: 10.1182/hematology.2019000055] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
In countries with access to organized health care, survival of children with sickle cell disease (SCD) has greatly improved, resulting in a growing population of adults with SCD. Transition from pediatric to adult care presents many challenges for the patient, who now faces the reality of emerging complications in many organs that are cumulative, adding to other age-related nonsickle conditions that interact and add to the disease morbidity. We recommend regular comprehensive annual assessments, monitoring for early signs of organ damage and joint clinics with relevant specialists, if applicable. While maintaining a low threshold for intervention with disease-modifying therapies, we should always keep in mind that there is no single complication that is pathognomonic of SCD, and nonsickle comorbidities should always be excluded and treated if present. We need to reevaluate our approach to managing adults with SCD by putting a greater emphasis on multidisciplinary care while proactively considering curative options (hematopoietic stem cell transplant and gene therapy) and experimental pharmacological agents for adults with SCD of all ages before complications render the patients ineligible for these treatments.
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Affiliation(s)
- Jo Howard
- Department of Haematology, Guy's and St Thomas' Hospitals NHS Foundation Trust, London, United Kingdom; and
| | - Swee Lay Thein
- Sickle Cell Branch, National Heart, Lung, and Blood Institute/National Institutes of Health, Bethesda, MD
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31
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Derebail VK, Zhou Q, Ciccone EJ, Cai J, Ataga KI. Rapid decline in estimated glomerular filtration rate is common in adults with sickle cell disease and associated with increased mortality. Br J Haematol 2019; 186:900-907. [PMID: 31168785 DOI: 10.1111/bjh.16003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Accepted: 04/23/2019] [Indexed: 12/14/2022]
Abstract
We evaluated the prevalence of rapid decline in kidney function, its potential risk factors and influence upon mortality in sickle cell disease (SCD) in a retrospective single-center study. Rapid decline of kidney function was defined as estimated glomerular filtration rate (eGFR) loss of >3·0 ml/min/1·73 m2 per year. A multivariable logistic regression model for rapid eGFR decline was constructed after evaluating individual covariates. We constructed multivariate Cox-regression models for rapid eGFR decline and mortality. Among 331 SCD patients (median age 29 years [interquartile range, IQR: 20, 41]; 187 [56·5%] female) followed for median 4·01 years (IQR: 1·66, 7·19), rapid eGFR decline was noted in 103 (31·1%). History of stroke (odds ratio [OR]: 2·91, 95% confidence interval [CI]: 1·25-6·77) and use of angiotensin converting enzyme inhibitors/angiotensin receptor blockers (OR: 3·17, 95% CI: 1·28-7·84) were associated with rapid eGFR decline. The rate of eGFR change over time was associated with mortality (hazard ratio [HR]: 0·99, 95% CI: 0·984-0·995, P = 0·0002). In Cox-regression, rapid eGFR decline associated with mortality (HR: 2·07, 95% CI: 1·039-4·138, P = 0·04) adjusting for age, sex and history of stroke. Rapid eGFR decline is common in SCD and associated with increased mortality. Long-term studies are needed to determine whether attenuating loss of kidney function may decrease mortality in SCD.
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Affiliation(s)
- Vimal K Derebail
- Division of Nephrology and Hypertension, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Qingning Zhou
- Department of Mathematics and Statistics, University of North Carolina at Charlotte, Charlotte, NC, USA
| | - Emily J Ciccone
- Division of Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Jianwen Cai
- Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Kenneth I Ataga
- Center for Sickle Cell Disease, University of Tennessee Health Science Center, Memphis, TN, USA
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