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Razazi K, Berti E, Cecchini J, Carteaux G, Habibi A, Bartolucci P, Arrestier R, Gendreau S, de Prost N, Hulin A, Dessap AM. Decreased risk of underdosing with continuous infusion versus intermittent administration of cefotaxime in patients with sickle cell disease and acute chest syndrome. PLoS One 2024; 19:e0302298. [PMID: 38635540 PMCID: PMC11025818 DOI: 10.1371/journal.pone.0302298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2021] [Accepted: 04/01/2024] [Indexed: 04/20/2024] Open
Abstract
OBJECTIVE Underdosing of antibiotics is common in patients with sickle cell disease (SCD). We hypothesized that in critically-ill patients with SCD receiving cefotaxime during acute chest syndrome, the continuous infusion may outperform the intermittent administration in achieving pharmacokinetic/pharmacodynamic targets. DESIGN Prospective before-after study. SETTINGS Intensive-care unit of a French teaching hospital and sickle cell disease referral center. PATIENTS Sixty consecutive episodes of severe acute chest syndrome in 58 adult patients with sickle cell disease. INTERVENTIONS Patients were treated with intermittent administration during the first period (April 2016 -April 2018) and with continuous infusion during the second period (May 2018 -August 2019). MEASUREMENTS AND MAIN RESULTS We included 60 episodes of acute chest syndrome in 58 patients (29 [25-34] years, 37/58 (64%) males). Daily dose of cefotaxime was similar between groups (59 [48-88] vs. 61 [57-64] mg/kg/day, p = 0.84). Most patients (>75%) presented a glomerular hyperfiltration with no difference between groups (p = 0.25). More patients had a cefotaxime trough level ≥2 mg/L with continuous infusion than intermittent administration: 28 (93%) vs. 5 (16%), p<0.001. The median residual concentration was higher in the continuous infusion than intermittent administration group: 10.5 [7.4-13.3] vs. 0 [0-0] mg/L, p<0.001. No infection relapse was observed in the entire cohort. Hospital length of stay was similar between groups. CONCLUSION As compared to intermittent administration, continuous infusion of cefotaxime maximizes the pharmacokinetic/pharmacodynamic parameters in patients with SCD. The clinical outcome did not differ between the two administration methods; however, the study was underpowered to detect such a difference.
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Affiliation(s)
- Keyvan Razazi
- AP-HP, Hôpitaux Universitaires Henri-Mondor, Service de Médecine Intensive Réanimation, F-94010, Créteil, France
- Université Paris Est Créteil, INSERM, IMRB, Créteil, F-94010, France
- Université Paris Est Créteil, CARMAS, Créteil, F-94010, France
| | - Enora Berti
- AP-HP, Hôpitaux Universitaires Henri-Mondor, Service de Médecine Intensive Réanimation, F-94010, Créteil, France
- Université Paris Est Créteil, CARMAS, Créteil, F-94010, France
| | - Jerome Cecchini
- AP-HP, Hôpitaux Universitaires Henri-Mondor, Service de Médecine Intensive Réanimation, F-94010, Créteil, France
- Université Paris Est Créteil, CARMAS, Créteil, F-94010, France
- Hôpital Intercommunal de Créteil, Service de Réanimation et Surveillance Continue Adulte, 94000, Créteil, France
| | - Guillaume Carteaux
- AP-HP, Hôpitaux Universitaires Henri-Mondor, Service de Médecine Intensive Réanimation, F-94010, Créteil, France
- Université Paris Est Créteil, INSERM, IMRB, Créteil, F-94010, France
- Université Paris Est Créteil, CARMAS, Créteil, F-94010, France
| | - Anoosha Habibi
- Université Paris Est Créteil, INSERM, IMRB, Créteil, F-94010, France
- AP-HP, Hôpitaux Universitaires Henri-Mondor, Centre de Référence de la Drépanocytose, Créteil, France
| | - Pablo Bartolucci
- Université Paris Est Créteil, INSERM, IMRB, Créteil, F-94010, France
- AP-HP, Hôpitaux Universitaires Henri-Mondor, Centre de Référence de la Drépanocytose, Créteil, France
| | - Romain Arrestier
- AP-HP, Hôpitaux Universitaires Henri-Mondor, Service de Médecine Intensive Réanimation, F-94010, Créteil, France
- Université Paris Est Créteil, INSERM, IMRB, Créteil, F-94010, France
- Université Paris Est Créteil, CARMAS, Créteil, F-94010, France
| | - Ségolène Gendreau
- AP-HP, Hôpitaux Universitaires Henri-Mondor, Service de Médecine Intensive Réanimation, F-94010, Créteil, France
- Université Paris Est Créteil, INSERM, IMRB, Créteil, F-94010, France
- Université Paris Est Créteil, CARMAS, Créteil, F-94010, France
| | - Nicolas de Prost
- AP-HP, Hôpitaux Universitaires Henri-Mondor, Service de Médecine Intensive Réanimation, F-94010, Créteil, France
- Université Paris Est Créteil, INSERM, IMRB, Créteil, F-94010, France
- Université Paris Est Créteil, CARMAS, Créteil, F-94010, France
| | - Anne Hulin
- AP-HP, Hôpitaux Universitaires Henri Mondor, Service de Biochimie, Créteil, 94010 France
| | - Armand Mekontso Dessap
- AP-HP, Hôpitaux Universitaires Henri-Mondor, Service de Médecine Intensive Réanimation, F-94010, Créteil, France
- Université Paris Est Créteil, INSERM, IMRB, Créteil, F-94010, France
- Université Paris Est Créteil, CARMAS, Créteil, F-94010, France
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Zahr RS, Saraf SL. Sickle Cell Disease and CKD: An Update. Am J Nephrol 2023; 55:56-71. [PMID: 37899028 PMCID: PMC10872505 DOI: 10.1159/000534865] [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: 09/28/2023] [Accepted: 10/25/2023] [Indexed: 10/31/2023]
Abstract
BACKGROUND Sickle cell disease is an inherited red blood cell disorder that affects approximately 100,000 people in the USA and 25 million people worldwide. Vaso-occlusion and chronic hemolysis lead to dysfunction of vital organ systems, with the kidneys being among the most commonly affected organs. SUMMARY Early renal manifestations include medullary ischemia with the loss of urine-concentrating ability and hyperfiltration. This can be followed by progressive damage characterized by persistent albuminuria and a decline in the estimated glomerular filtration rate. The risk of sickle nephropathy is greater in those with the APOL1 G1 and G2 kidney risk variants and variants in HMOX1 and lower in those that coinherit α-thalassemia. Therapies to treat sickle cell disease-related kidney damage focus on sickle cell disease-modifying therapies (e.g., hydroxyurea) or those adopted from the nonsickle cell disease kidney literature (e.g., renin-angiotensin-aldosterone system inhibitors), although data on their clinical efficacy are limited to small studies with short follow-up periods. Kidney transplantation for end-stage kidney disease improves survival compared to hemodialysis but is underutilized in this patient population. KEY MESSAGES Kidney disease is a major contributor to early mortality, and more research is needed to understand the pathophysiology and develop targeted therapies to improve kidney health in sickle cell disease.
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Affiliation(s)
- Rima S. Zahr
- Division of Pediatric Nephrology and Hypertension, University of Tennessee Health Science Center, Memphis, TN
| | - Santosh L. Saraf
- Division of Hematology & Oncology, University of Illinois Chicago, Chicago, IL
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Ranque B, Diaw M, Dembele AK, Lapoumeroulie C, Offredo L, Tessougue O, Gueye SM, Diallo D, Diop S, Colin-Aronovicz Y, Jouven X, Blanc-Brude O, Tharaux PL, Le Jeune S, Connes P, Romana M, Le Van Kim C. Association of haemolysis markers, blood viscosity and microcirculation function with organ damage in sickle cell disease in sub-Saharan Africa (the BIOCADRE study). Br J Haematol 2023; 203:319-326. [PMID: 37583261 DOI: 10.1111/bjh.19006] [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: 04/22/2023] [Revised: 06/27/2023] [Accepted: 07/18/2023] [Indexed: 08/17/2023]
Abstract
Sickle cell anaemia (SCA) is a monogenic disease with a highly variable clinical course. We aimed to investigate associations between microvascular function, haemolysis markers, blood viscosity and various types of SCA-related organ damage in a multicentric sub-Saharan African cohort of patients with SCA. In a cross-sectional study, we selected seven groups of adult patients with SS phenotype in Dakar and Bamako based on the following complications: leg ulcer, priapism, osteonecrosis, retinopathy, high tricuspid regurgitant jet velocity (TRV), macro-albuminuria or none. Clinical assessment, echocardiography, peripheral arterial tonometry, laboratory tests and blood viscosity measurement were performed. We explored statistical associations between the biological parameters and the six studied complications. Among 235 patients, 58 had high TRV, 46 osteonecrosis, 43 priapism, 33 leg ulcers, 31 retinopathy and 22 macroalbuminuria, whereas 36 had none of these complications. Multiple correspondence analysis revealed no cluster of complications. Lactate dehydrogenase levels were associated with high TRV, and blood viscosity was associated with retinopathy and the absence of macroalbuminuria. Despite extensive phenotyping of patients, no specific pattern of SCA-related complications was identified. New biomarkers are needed to predict SCA clinical expression to adapt patient management, especially in Africa, where healthcare resources are scarce.
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Affiliation(s)
- Brigitte Ranque
- Université Paris Cité, Inserm, UMR S970, PARCC, Paris, France
- Service de Médecine Interne, Hôpital Européen Georges Pompidou, Assistance Publique des Hôpitaux de Paris, Paris, France
- LABEX GREX, Université Paris Cité, Paris, France
| | - Mor Diaw
- Laboratoire de Physiologie et Explorations Fonctionnelles, Faculté de Médecine, Pharmacie et Odontologie Université Cheikh Anta Diop de Dakar, Dakar, Senegal
- Unité Mixte Internationale (UMI 3189), "Environnement, Santé, Sociétés" CNRS, UCAD, CNRST, USTTB, UGB, Dakar, Senegal
| | | | | | - Lucile Offredo
- Université Paris Cité, Inserm, UMR S970, PARCC, Paris, France
| | - Oumar Tessougue
- Centre de Recherche et de Lutte Contre la Drépanocytose (CRLD), Bamako, Mali
| | | | - Dapa Diallo
- Centre de Recherche et de Lutte Contre la Drépanocytose (CRLD), Bamako, Mali
| | - Saliou Diop
- Centre National de Transfusion Sanguine (CNTS), Dakar, Senegal
| | - Yves Colin-Aronovicz
- LABEX GREX, Université Paris Cité, Paris, France
- Université Paris Cité and Université des Antilles, Inserm, BIGR, Paris, France
| | - Xavier Jouven
- Université Paris Cité, Inserm, UMR S970, PARCC, Paris, France
- LABEX GREX, Université Paris Cité, Paris, France
| | - Olivier Blanc-Brude
- Université Paris Cité, Inserm, UMR S970, PARCC, Paris, France
- LABEX GREX, Université Paris Cité, Paris, France
| | - Pierre-Louis Tharaux
- Université Paris Cité, Inserm, UMR S970, PARCC, Paris, France
- LABEX GREX, Université Paris Cité, Paris, France
| | - Sylvain Le Jeune
- Université Paris Cité, Inserm, UMR S970, PARCC, Paris, France
- Service de Médecine Interne, Hôpital Avicenne, Bobigny, Assistance-Publique Hôpitaux de Paris, Paris, France
| | - Philippe Connes
- LABEX GREX, Université Paris Cité, Paris, France
- Université Lyon 1, Laboratoire LIBM EA7424, Equipe «Biologie Vasculaire et du Globule Rouge», COMUE, Lyon, France
| | - Marc Romana
- LABEX GREX, Université Paris Cité, Paris, France
- Université Paris Cité and Université des Antilles, Inserm, BIGR, Paris, France
| | - Caroline Le Van Kim
- LABEX GREX, Université Paris Cité, Paris, France
- Université Paris Cité and Université des Antilles, Inserm, BIGR, Paris, France
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Roy NB, Carpenter A, Dale-Harris I, Dorée C, Estcourt LJ. Interventions for chronic kidney disease in people with sickle cell disease. Cochrane Database Syst Rev 2023; 8:CD012380. [PMID: 37539955 PMCID: PMC10404133 DOI: 10.1002/14651858.cd012380.pub3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/05/2023]
Abstract
BACKGROUND Sickle cell disease (SCD), one of the commonest severe monogenic disorders, is caused by the inheritance of two abnormal haemoglobin (beta-globin) genes. SCD can cause severe pain, significant end-organ damage, pulmonary complications, and premature death. Kidney disease is a frequent and potentially severe complication in people with SCD. Chronic kidney disease (CKD) is defined as abnormalities of kidney structure or function present for more than three months. Sickle cell nephropathy refers to the spectrum of kidney complications in SCD. Glomerular damage is a cause of microalbuminuria and can develop at an early age in children with SCD, with increased prevalence in adulthood. In people with sickle cell nephropathy, outcomes are poor as a result of the progression to proteinuria and chronic kidney insufficiency. Up to 12% of people who develop sickle cell nephropathy will develop end-stage renal disease. This is an update of a review first published in 2017. OBJECTIVES To assess the effectiveness of any intervention for preventing or reducing kidney complications or chronic kidney disease in people with sickle cell disease. Possible interventions include red blood cell transfusions, hydroxyurea, and angiotensin-converting enzyme inhibitors (ACEIs), either alone or in combination. SEARCH METHODS We searched for relevant trials in the Cochrane Cystic Fibrosis and Genetic Disorders Group Trials Register, CENTRAL, MEDLINE, Embase, seven other databases, and two other trials registers. SELECTION CRITERIA Randomised controlled trials (RCTs) comparing interventions to prevent or reduce kidney complications or CKD in people with SCD. We applied no restrictions related to outcomes examined, language, or publication status. DATA COLLECTION AND ANALYSIS Two review authors independently assessed trial eligibility, extracted data, assessed the risk of bias, and assessed the certainty of the evidence (GRADE). MAIN RESULTS We included three RCTs with 385 participants. We rated the certainty of the evidence as low to very low across different outcomes according to GRADE methodology, downgrading for risk of bias concerns, indirectness, and imprecision. Hydroxyurea versus placebo One RCT published in 2011 compared hydroxyurea to placebo in 193 children aged nine to 18 months. We are unsure if hydroxyurea compared to placebo reduces or prevents progression of kidney disease assessed by change in glomerular filtration rate (mean difference (MD) 0.58 mL/min /1.73 m2, 95% confidence interval (CI) -14.60 to 15.76; 142 participants; very low certainty). Hydroxyurea compared to placebo may improve the ability to concentrate urine (MD 42.23 mOsm/kg, 95% CI 12.14 to 72.32; 178 participants; low certainty), and may make little or no difference to SCD-related serious adverse events, including acute chest syndrome (risk ratio (RR) 0.39, 99% CI 0.13 to 1.16; 193 participants; low certainty), painful crisis (RR 0.68, 99% CI 0.45 to 1.02; 193 participants; low certainty); and hospitalisations (RR 0.83, 99% CI 0.68 to 1.01; 193 participants; low certainty). No deaths occurred in either trial arm and the RCT did not report quality of life. Angiotensin-converting enzyme inhibitors versus placebo One RCT published in 1998 compared an ACEI (captopril) to placebo in 22 adults with normal blood pressure and microalbuminuria. We are unsure if captopril compared to placebo reduces proteinuria (MD -49.00 mg/day, 95% CI -124.10 to 26.10; 22 participants; very low certainty). We are unsure if captopril reduces or prevents kidney disease as measured by creatinine clearance; the trial authors stated that creatinine clearance remained constant over six months in both groups, but provided no comparative data (very low certainty). The RCT did not report serious adverse events, all-cause mortality, or quality of life. Angiotensin-converting enzyme inhibitors versus vitamin C One RCT published in 2020 compared an ACEI (lisinopril) with vitamin C in 170 children aged one to 18 years with normal blood pressure and microalbuminuria. It reported no data we could analyse. We are unsure if lisinopril compared to vitamin C reduces proteinuria in this population: the large drop in microalbuminuria in both arms of the trial after only one month on treatment may have been due to an overestimation of microalbuminuria at baseline rather than a true effect. The RCT did not report serious adverse events, all-cause mortality, or quality of life. AUTHORS' CONCLUSIONS We are unsure if hydroxyurea improves glomerular filtration rate or reduces hyperfiltration in children aged nine to 18 months, but it may improve their ability to concentrate urine and may make little or no difference to the incidence of acute chest syndrome, painful crises, and hospitalisations. We are unsure if ACEI compared to placebo has any effect on preventing or reducing kidney complications in adults with normal blood pressure and microalbuminuria. We are unsure if ACEI compared to vitamin C has any effect on preventing or reducing kidney complications in children with normal blood pressure and microalbuminuria. No RCTs assessed red blood cell transfusions or any combined interventions to prevent or reduce kidney complications. Due to lack of evidence, we cannot comment on the management of children aged over 18 months or adults with any known genotype of SCD. We have identified a lack of adequately designed and powered studies, although we found four ongoing trials since the last version of this review. Only one ongoing trial addresses renal function as a primary outcome in the short term, but such interventions have long-term effects. Trials of hydroxyurea, ACEIs or red blood cell transfusion in older children and adults are urgently needed to determine any effect on prevention or reduction of kidney complications in people with SCD.
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Affiliation(s)
- Noemi Ba Roy
- Department of Haematology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | | | | | - Carolyn Dorée
- Systematic Review Initiative, NHS Blood and Transplant, Oxford, UK
| | - Lise J Estcourt
- Haematology/Transfusion Medicine, NHS Blood and Transplant, Oxford, UK
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Saroja T, Kalpana Y. Adaptive Weight Dynamic Butterfly Optimization Algorithm (ADBOA)-Based Feature Selection and Classifier for Chronic Kidney Disease (CKD) Diagnosis. INTERNATIONAL JOURNAL OF COMPUTATIONAL INTELLIGENCE AND APPLICATIONS 2023. [DOI: 10.1142/s1469026823410018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2023]
Abstract
Chronic Kidney Disease (CKD) are a universal issue for the well-being of people as they result in morbidities and deaths with the onset of additional diseases. Because there are no clear early symptoms of CKD, people frequently miss them. Timely identification of CKD allows individuals to acquire proper medications to prevent the development of the diseases. Machine learning technique (MLT) can strongly assist doctors in achieving this aim due to their rapid and precise determination capabilities. Many MLT encounter inappropriate features in most databases that might lower the classifier’s performance. Missing values are filled using K-Nearest Neighbor (KNN). Adaptive Weight Dynamic Butterfly Optimization Algorithm (AWDBOA) are nature-inspired feature selection (FS) techniques with good explorations, exploitations, convergences, and do not get trapped in local optimums. Operators used in Local Search Algorithm-Based Mutation (LSAM) and Butterfly Optimization Algorithm (BOA) which use diversity and generations of adaptive weights to features for enhancing FS are modified in this work. Simultaneously, an adaptive weight value is added for FS from the database. Following the identification of features, six MLT are used in classification tasks namely Logistic Regressions (LOG), Random Forest (RF), Support Vector Machine (SVM), KNNs, Naive Baye (NB), and Feed Forward Neural Network (FFNN). The CKD databases were retrieved from MLT repository of UCI (University of California, Irvine). Precision, Recall, F1-Score, Sensitivity, Specificity, and accuracy are compared to assess this work’s classification framework with existing approaches.
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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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Ndour EHM, Mnika K, Tall FG, Seck M, Ly ID, Nembaware V, Mazandu GK, Sagna Bassène HAT, Dione R, Ndongo AA, Diop JPD, Barry NOK, Djité M, Ndiaye Diallo R, Guèye PM, Diop S, Diagne I, Cissé A, Wonkam A, Lopez Sall P. Biomarkers of sickle cell nephropathy in Senegal. PLoS One 2022; 17:e0273745. [PMID: 36409722 PMCID: PMC9678278 DOI: 10.1371/journal.pone.0273745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 08/15/2022] [Indexed: 11/22/2022] Open
Abstract
Sickle cell anemia (SCA) is caused by a single point variation in the β-globin gene (HBB): c.20A> T (p.Glu7Val), in homozygous state. SCA is characterized by sickling of red blood cells in small blood vessels which leads to a range of multiorgan complications, including kidney dysfunction. This case-control study aims at identifying sickle cell nephropathy biomarkers in a group of patients living with SCA from Senegal. A total of 163 patients living with SCA and 177 ethnic matched controls were investigated. Biological phenotyping included evaluation of glycemia, glucosuria, albuminuria, proteinuria, tubular proteinuria, serum creatinine, urine creatinine, urine specific gravity and glomerular filtration rate. Descriptive statistics of biomarkers were performed using the χ2 -test, with the significance level set at p<0.05. Patients living with SCA had a median age of 20 years (range 4 to 57) with a female sex frequency of 53.21%. The median age of the control participants was 29 years (range: 4-77) with a female sex frequency of 66.09%. The following proportions of abnormal biological indices were observed in SCA patients versus (vs.) controls, as follows: hyposthenuria: 35.3%vs.5.2% (p<0.001); glomerular hyperfiltration: 47.66%vs.19.75% (p<0.001), renal insufficiency: 5.47%vs.3.82% (p = 0.182); microalbuminuria: 42.38%vs.5.78% (p<0.001); proteinuria: 39.33%vs.4.62% (p<0.001); tubular proteinuria: 40.97%vs.4.73% (p<0.001) and microglucosuria: 22.5%vs.5.1% (p<0.001). This study shows a relatively high proportion of SCA nephropathy among patients living with SCA in Senegal. Microglucosuria, proteinuria, tubular proteinuria, microalbuminuria, hyposthenuria and glomerular hyperfiltration are the most prevalent biomarkers of nephropathy in this group of Senegalese patients with SCA.
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Affiliation(s)
- El Hadji Malick Ndour
- Department of Pharmaceutical Biochemistry, Faculty of Medicine, Pharmacy and Dentistry, Cheikh Anta Diop University, Dakar, Senegal
- Albert Royer National University Hospital of Children, Dakar, Senegal
- * E-mail:
| | - Khuthala Mnika
- Division of Human Genetics, Department of Pathology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
- Division of Human Genetics, National Health Laboratory Service, and School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Fatou Guèye Tall
- Department of Pharmaceutical Biochemistry, Faculty of Medicine, Pharmacy and Dentistry, Cheikh Anta Diop University, Dakar, Senegal
- Albert Royer National University Hospital of Children, Dakar, Senegal
| | - Moussa Seck
- National Center of Blood Transfusion, Dakar, Senegal
| | - Indou Dème Ly
- Albert Royer National University Hospital of Children, Dakar, Senegal
| | - Victoria Nembaware
- Division of Human Genetics, Department of Pathology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Gaston Kuzamunu Mazandu
- Division of Human Genetics, Department of Pathology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | | | - Rokhaya Dione
- Albert Royer National University Hospital of Children, Dakar, Senegal
| | | | - Jean Pascal Demba Diop
- Department of Human Genetics, Faculty of Medicine, Pharmacy and Dentistry, Cheikh Anta Diop University, Dakar, Senegal
| | - Nènè Oumou Kesso Barry
- Department of Pharmaceutical Biochemistry, Faculty of Medicine, Pharmacy and Dentistry, Cheikh Anta Diop University, Dakar, Senegal
| | - Moustapha Djité
- Department of Pharmaceutical Biochemistry, Faculty of Medicine, Pharmacy and Dentistry, Cheikh Anta Diop University, Dakar, Senegal
| | - Rokhaya Ndiaye Diallo
- Department of Human Genetics, Faculty of Medicine, Pharmacy and Dentistry, Cheikh Anta Diop University, Dakar, Senegal
| | - Papa Madièye Guèye
- Department of Pharmaceutical Biochemistry, Faculty of Medicine, Pharmacy and Dentistry, Cheikh Anta Diop University, Dakar, Senegal
| | - Saliou Diop
- National Center of Blood Transfusion, Dakar, Senegal
| | - Ibrahima Diagne
- Department of Pediatrics, Faculty of Health Sciences, Gaston Berger University, Saint-Louis, Senegal
| | - Aynina Cissé
- Department of Pharmaceutical Biochemistry, Faculty of Medicine, Pharmacy and Dentistry, Cheikh Anta Diop University, Dakar, Senegal
| | - Ambroise Wonkam
- Division of Human Genetics, Department of Pathology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
- McKusick-Nathans Institute and Department of Genetic Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
| | - Philomène Lopez Sall
- Department of Pharmaceutical Biochemistry, Faculty of Medicine, Pharmacy and Dentistry, Cheikh Anta Diop University, Dakar, Senegal
- Albert Royer National University Hospital of Children, Dakar, Senegal
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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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Umeukeje EM, Koonce TY, Kusnoor SV, Ulasi II, Kostelanetz S, Williams AM, Blasingame MN, Epelbaum MI, Giuse DA, Apple AN, Kaur K, González Peña T, Barry D, Eisenstein LG, Nutt CT, Giuse NB. Systematic review of international studies evaluating MDRD and CKD-EPI estimated glomerular filtration rate (eGFR) equations in Black adults. PLoS One 2022; 17:e0276252. [PMID: 36256652 PMCID: PMC9578594 DOI: 10.1371/journal.pone.0276252] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 10/03/2022] [Indexed: 11/17/2022] Open
Abstract
Use of race adjustment in estimating glomerular filtration rate (eGFR) has been challenged given concerns that it may negatively impact the clinical care of Black patients, as it results in Black patients being systematically assigned higher eGFR values than non-Black patients. We conducted a systematic review to assess how well eGFR, with and without race adjustment, estimates measured GFR (mGFR) in Black adults globally. A search across multiple databases for articles published from 1999 to May 2021 that compared eGFR to mGFR and reported outcomes by Black race was performed. We included studies that assessed eGFR using the Modification of Diet in Renal Disease (MDRD) and Chronic Kidney Disease Epidemiology Collaboration (CKD-EPICr) creatinine equations. Risk of study bias and applicability were assessed with the QUality Assessment of Diagnostic Accuracy Studies-2. Of 13,167 citations identified, 12 met the data synthesis criteria (unique patient cohorts in which eGFR was compared to mGFR with and without race adjustment). The studies included patients with and without kidney disease from Africa (n = 6), the United States (n = 3), Europe (n = 2), and Brazil (n = 1). Of 11 CKD-EPI equation studies, all assessed bias, 8 assessed accuracy, 6 assessed precision, and 5 assessed correlation/concordance. Of 7 MDRD equation studies, all assessed bias, 6 assessed accuracy, 5 assessed precision, and 3 assessed correlation/concordance. The majority of studies found that removal of race adjustment improved bias, accuracy, and precision of eGFR equations for Black adults. Risk of study bias was often unclear, but applicability concerns were low. Our systematic review supports the need for future studies to be conducted in diverse populations to assess the possibility of alternative approaches for estimating GFR. This study additionally provides systematic-level evidence for the American Society of Nephrology-National Kidney Foundation Task Force efforts to pursue other options for GFR estimation.
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Affiliation(s)
- Ebele M. Umeukeje
- Division of Nephrology and Hypertension, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, United States of America
- Vanderbilt Center for Kidney Disease, Vanderbilt University Medical Center, Nashville, TN, United States of America
| | - Taneya Y. Koonce
- Center for Knowledge Management, Vanderbilt University Medical Center, Nashville, TN, United States of America
- * E-mail:
| | - Sheila V. Kusnoor
- Center for Knowledge Management, Vanderbilt University Medical Center, Nashville, TN, United States of America
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, United States of America
| | - Ifeoma I. Ulasi
- Renal Unit, Department of Medicine, College of Medicine, University of Nigeria/University of Nigeria Teaching Hospital, Ituku-Ozalla, Nigeria
| | - Sophia Kostelanetz
- Division of General Internal Medicine and Public Health, Vanderbilt University Medical Center, Nashville, TN, United States of America
| | - Annette M. Williams
- Center for Knowledge Management, Vanderbilt University Medical Center, Nashville, TN, United States of America
| | - Mallory N. Blasingame
- Center for Knowledge Management, Vanderbilt University Medical Center, Nashville, TN, United States of America
| | - Marcia I. Epelbaum
- Center for Knowledge Management, Vanderbilt University Medical Center, Nashville, TN, United States of America
| | - Dario A. Giuse
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, United States of America
| | - Annie N. Apple
- Vanderbilt University School of Medicine, Nashville, TN, United States of America
| | - Karampreet Kaur
- Vanderbilt University School of Medicine, Nashville, TN, United States of America
| | - Tavia González Peña
- Vanderbilt University School of Medicine, Nashville, TN, United States of America
| | - Danika Barry
- Department of Obstetrics & Gynecology, McGaw Medical Center of Northwestern University, Chicago, IL, United States of America
| | - Leo G. Eisenstein
- Department of Medicine, NYU Langone Medical Center, New York, NY, United States of America
| | - Cameron T. Nutt
- Department of Medicine, Brigham and Women’s Hospital, Boston, MA, United States of America
| | - Nunzia B. Giuse
- Center for Knowledge Management, Vanderbilt University Medical Center, Nashville, TN, United States of America
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, United States of America
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, United States of America
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10
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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: 2] [Impact Index Per Article: 1.0] [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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11
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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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12
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Huriez P, Ourghanlian C, Razazi K, Vindrios W, Hulin A, Lepeule R, Habibi A, Gallien S. Probenecid, an old β-lactams pharmacokinetic enhancer for a renewed use: a retrospective study. Infect Dis Now 2022; 52:273-279. [DOI: 10.1016/j.idnow.2022.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 04/13/2022] [Accepted: 05/23/2022] [Indexed: 11/28/2022]
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13
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Saraf SL, Derebail VK, Zhang X, Machado RF, Gordeuk VR, Lash JP, Little J. Hyperkalemia and Metabolic Acidosis Occur at a Higher eGFR in Sickle Cell Disease. KIDNEY360 2022; 3:608-614. [PMID: 35721605 DOI: 10.34067/kid.0006802021] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 01/27/2022] [Indexed: 11/27/2022]
Abstract
Background People with sickle cell disease (SCD) have an elevated estimated glomerular filtration rate (eGFR) compared with the general population, and this may alter the usual creatinine-based eGFR cutoffs for which physiologic evidence of kidney dysfunction is apparent. This study aimed to identify eGFR thresholds for hyperkalemia and metabolic acidosis in patients with SCD. Methods This was a cross-sectional analysis of 733 patients with severe (hemoglobin SS or Sβ 0-thalassemia) SCD genotype, 238 patients with moderate (hemoglobin SC or Sβ +-thalassemia) SCD genotype, and 1333 age- and sex-matched African Americans from the National Health and Nutrition Examination Survey (NHANES). The prevalence rates of hyperkalemia and metabolic acidosis were compared by eGFR category. Cutoffs for hyperkalemia and metabolic acidosis were determined using generalized additive models. Results Hyperkalemia and metabolic acidosis were more common in those with severe SCD genotype (13% and 21%, respectively) compared with the NHANES (0.3% and 5%, respectively); the prevalence rates in the moderate SCD genotype were intermediate for hyperkalemia (3%) and metabolic acidosis (11%). The proportion of patients with hyperkalemia and metabolic acidosis progressively increased with lower eGFR category in both SCD genotype groups. The eGFR thresholds for hyperkalemia and metabolic acidosis were higher in the severe (85 and 91 ml/min per 1.73 m2, respectively) and moderate (52 and 102 ml/min per 1.73 m2, respectively) SCD genotypes compared with the NHANES (34 and 46 ml/min per 1.73 m2). Conclusions We demonstrate that hyperkalemia and metabolic acidosis are more common and occur at higher eGFR values in patients with SCD compared with age- and sex-matched African Americans, including in eGFR ranges considered to be normal. Future studies using redefined creatinine-based eGFR thresholds for abnormal kidney function may identify high-risk patients for earlier intervention strategies and referral for specialized renal care in SCD.
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Affiliation(s)
- Santosh L Saraf
- Department of Medicine, Division of Hematology and Oncology, University of Illinois at Chicago, Chicago, Illinois
| | - Vimal K Derebail
- Department of Medicine, Division of Nephrology and Hypertension, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Xu Zhang
- Department of Medicine, Division of Hematology and Oncology, University of Illinois at Chicago, Chicago, Illinois
| | - Roberto F Machado
- Department of Medicine, Division of Pulmonary Medicine, University of Indiana, Indianapolis, Indiana
| | - Victor R Gordeuk
- Department of Medicine, Division of Hematology and Oncology, University of Illinois at Chicago, Chicago, Illinois
| | - James P Lash
- Department of Medicine, Division of Nephrology, University of Illinois at Chicago, Chicago, Illinois
| | - Jane Little
- Department of Medicine, Division of Hematology & Oncology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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14
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Safdar OY, Baghdadi RM, Alahmadi SA, Fakieh BE, Algaydi AM. Sickle cell nephropathy: A review of novel biomarkers and their potential roles in early detection of renal involvement. World J Clin Pediatr 2022; 11:14-26. [PMID: 35096543 PMCID: PMC8771312 DOI: 10.5409/wjcp.v11.i1.14] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 08/12/2021] [Accepted: 11/15/2021] [Indexed: 02/06/2023] Open
Abstract
Whether the underlying mutations are homozygous, heterozygous, or co-inherited with other hemoglobinopathies, sickle cell disease is known to afflict the kidneys, leading to the clinical entity known as sickle cell nephropathy (SCN). Although common, SCN remains diagnostically elusive. Conventional studies performed in the context of renal disorders often fail to detect early stage SCN. This makes the quest for early diagnosis and treatment more challenging, and it increases the burden of chronic kidney disease-related morbidity among patients. Novel diagnostic tools have been employed to overcome this limitation. In this study, we discuss various biomarkers of SCN, including those employed in clinical practice and others recently identified in experimental settings, such as markers of vascular injury, endothelial dysfunction, tubulo-glomerular damage, and oxidative stress. These include kidney injury molecule-1, monocyte chemoattractant protein-1, N-acetyl-B-D-glucosaminidase, ceruloplasmin, orosomucoid, nephrin, and cation channels, among others. Furthermore, we explore the potential of novel biomarkers for refining diagnostic and therapeutic approaches and describe some obstacles that still need to be overcome. We highlight the importance of a collaborative approach to standardize the use of promising new biomarkers. Finally, we outline the limitations of conventional markers of renal damage as extensions of the pathogenic process occurring at the level of the organ and its functional subunits, with a discussion of the expected pattern of clinical and biochemical progression among patients with SCN.
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Affiliation(s)
- Osama Y Safdar
- Department of Pediatric, King Abdulaziz University, JEDDAH 21414, Saudi Arabia
| | - Rana M Baghdadi
- College of Medicine, King Abdulaziz University, JEDDAH 21422, Saudi Arabia
| | - Sereen A Alahmadi
- College of Medicine, King Abdulaziz University, JEDDAH 21422, Saudi Arabia
| | - Bana E Fakieh
- College of Medicine, King Abdulaziz University, JEDDAH 21422, Saudi Arabia
| | - Amaal M Algaydi
- College of Medicine, King Abdulaziz University, JEDDAH 21422, Saudi Arabia
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15
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Agbakou M, Mekontso-Dessap A, Pere M, Voiriot G, Picard M, Bourenne J, Ehrmann S, Canet E, Boyer A, Nseir S, Tamion F, Thille AW, Argaud L, Pontis E, Quenot JP, Schneider F, Hot A, Capellier G, Aubron C, Razazi K, Masseau A, Brule N, Reignier J, Lascarrou JB. Nationwide retrospective study of critically ill adults with sickle cell disease in France. Sci Rep 2021; 11:23132. [PMID: 34848756 PMCID: PMC8632921 DOI: 10.1038/s41598-021-02437-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 11/15/2021] [Indexed: 11/09/2022] Open
Abstract
Little is known about patients with sickle cell disease (SCD) who require intensive care unit (ICU) admission. The goals of this study were to assess outcomes in patients admitted to the ICU for acute complications of SCD and to identify factors associated with adverse outcomes. This multicenter retrospective study included consecutive adults with SCD admitted to one of 17 participating ICUs. An adverse outcome was defined as death or a need for life-sustaining therapies (non-invasive or invasive ventilation, vasoactive drugs, renal replacement therapy, and/or extracorporeal membrane oxygenation). Factors associated with adverse outcomes were identified by mixed multivariable logistic regression. We included 488 patients admitted in 2015-2017. The main reasons for ICU admission were acute chest syndrome (47.5%) and severely painful vaso-occlusive event (21.3%). Sixteen (3.3%) patients died in the ICU, mainly of multi-organ failure following a painful vaso-occlusive event or sepsis. An adverse outcome occurred in 81 (16.6%; 95% confidence interval [95% CI], 13.3%-19.9%) patients. Independent factors associated with adverse outcomes were low mean arterial blood pressure (adjusted odds ratio [aOR], 0.98; 95% CI 0.95-0.99; p = 0.027), faster respiratory rate (aOR, 1.09; 95% CI 1.05-1.14; p < 0.0001), higher haemoglobin level (aOR, 1.22; 95% CI 1.01-1.48; p = 0.038), impaired creatinine clearance at ICU admission (aOR, 0.98; 95% CI 0.97-0.98; p < 0.0001), and red blood cell exchange before ICU admission (aOR, 5.16; 95% CI 1.16-22.94; p = 0.031). Patients with SCD have a substantial risk of adverse outcomes if they require ICU admission. Early ICU admission should be encouraged in patients who develop abnormal physiological parameters.
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Affiliation(s)
- Maïté Agbakou
- Service de Médecine Intensive Réanimation, Centre Hospitalier Universitaire Hôtel-Dieu, 30 Bd. Jean Monnet, 44093, Nantes Cedex 1, France
| | - Armand Mekontso-Dessap
- Médecine Intensive Réanimation, Hôpital Henri Mondor, Assistance Publique des Hôpitaux de Paris, Créteil, France
| | - Morgane Pere
- Plateforme de methodologie et biostatistique, Direction de la Recherche de l'Innovation, Centre Hospitalier Universitaire de Nantes, Nantes, France
| | - Guillaume Voiriot
- Sorbonne Université, Assistance Publique Hôpitaux de Paris, Service de Médecine Intensive et Réanimation, Hôpital Tenon, Paris, France
| | - Muriel Picard
- Réanimation Polyvalente, Institut Universitaire du Cancer de Toulouse-Oncopole, CHU Toulouse, Toulouse, France
| | - Jérémy Bourenne
- Médecine Intensive Réanimation, Réanimation des Urgences, CHU la Timone 2, Marseille, France
| | - Stephan Ehrmann
- Médecine Intensive Réanimation, INSERM CIC 1415, CRICS-TriggerSEP Research Network, Centre Hospitalier Régional Universitaire de Tours and Centre d'Etude Des Pathologies Respiratoires (CEPR) INSERM U1100, Université de Tours, Tours, France
| | - Emmanuel Canet
- Service de Médecine Intensive Réanimation, Centre Hospitalier Universitaire Hôtel-Dieu, 30 Bd. Jean Monnet, 44093, Nantes Cedex 1, France
| | - Alexandre Boyer
- Médecine Intensive Réanimation, Hôpital Pellegrin, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
| | - Saad Nseir
- Médecine Intensive-Réanimation, CHU de Lille; Inserm U1285, Univ. Lille, CNRS, UMR 8576-UGSF-Unité de Glycobiologie Structurale et Fonctionnelle, 59000, Lille, France
| | - Fabienne Tamion
- Médecine Intensive Réanimation, Hôpital Charles Nicolle, Centre Hospitalier Universitaire de Rouen, Rouen, France
| | - Arnaud W Thille
- Médecine Intensive Réanimation, Centre Hospitalier Universitaire de Poitiers, Poitiers, France
| | - Laurent Argaud
- Médecine Intensive Réanimation, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
| | - Emmanuel Pontis
- Réanimation Médicale, Centre Hospitalier Universitaire de Rennes, Rennes, France
| | - Jean-Pierre Quenot
- Médecine Intensive Réanimation, Centre Hospitalier Universitaire de Dijon, Dijon, France
| | - Francis Schneider
- Médecine Intensive Réanimation, Hôpital de Hautepierre, Centre Hospitalier Universitaire de Strasbourg, Strasbourg, France
| | - Arnaud Hot
- Médecine Intensive Réanimation, Hôpital de la Croix Rousse, Hospices Civils de Lyon, Lyon, France
| | - Gilles Capellier
- Médecine Intensive Réanimation, Centre Hospitalier Régional Universitaire de Besançon, Besançon, France
| | - Cécile Aubron
- Réanimation Médicale, Hôpital de la Cavale Blanche, Centre Hospitalier Régional Universitaire de Bretagne Occidentale, Brest, France
| | - Keyvan Razazi
- Médecine Intensive Réanimation, Hôpital Henri Mondor, Assistance Publique des Hôpitaux de Paris, Créteil, France
| | - Agathe Masseau
- Médecine Interne, Centre Hospitalier Universitaire Nantes, Nantes, France
| | - Noëlle Brule
- Service de Médecine Intensive Réanimation, Centre Hospitalier Universitaire Hôtel-Dieu, 30 Bd. Jean Monnet, 44093, Nantes Cedex 1, France
| | - Jean Reignier
- Service de Médecine Intensive Réanimation, Centre Hospitalier Universitaire Hôtel-Dieu, 30 Bd. Jean Monnet, 44093, Nantes Cedex 1, France
| | - Jean-Baptiste Lascarrou
- Service de Médecine Intensive Réanimation, Centre Hospitalier Universitaire Hôtel-Dieu, 30 Bd. Jean Monnet, 44093, Nantes Cedex 1, France.
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16
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Adebayo OC, Betukumesu DK, Nkoy AB, Adesoji OM, Ekulu PM, Van den Heuvel LP, Levtchenko EN, Labarque V. Clinical and genetic factors are associated with kidney complications in African children with sickle cell anaemia. Br J Haematol 2021; 196:204-214. [PMID: 34545573 DOI: 10.1111/bjh.17832] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 08/19/2021] [Accepted: 09/02/2021] [Indexed: 12/11/2022]
Abstract
Clinical and genetic factors have been reported as influencing the development of sickle cell nephropathy (SCN). However, such data remain limited in the paediatric population. In this cross-sectional study, we enrolled 361 sickle cell disease children from the Democratic Republic of Congo. Participants were genotyped for the beta (β)-globin gene, apolipoprotein L1 (APOL1) risk variants, and haem oxygenase-1 (HMOX1) GT-dinucleotide repeats. As markers of kidney damage, albuminuria, hyperfiltration and decreased estimated glomerular filtration with creatinine (eGFRcr) were measured. An association of independent clinical and genetic factors with these markers of kidney damage were assessed via regression analysis. Genetic sequencing confirmed sickle cell anaemia in 326 participants. Albuminuria, hyperfiltration and decreased eGFRcr were present in 65 (20%), 52 (16%) and 18 (5·5%) patients, respectively. Regression analysis revealed frequent blood transfusions, indirect bilirubin and male gender as clinical predictors of SCN. APOL1 high-risk genotype (G1/G1, G2/G2 and G1/G2) was significantly associated with albuminuria (P = 0·04) and hyperfiltration (P = 0·001). HMOX1 GT-dinucleotide long repeats were significantly associated with lower eGFRcr. The study revealed a high burden of kidney damage among Congolese children and provided evidence of the possible role of APOL1 and HMOX1 in making children more susceptible to kidney complications.
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Affiliation(s)
- Oyindamola Christiana Adebayo
- Centre for Molecular and Vascular Biology, Department of Cardiovascular Sciences, Katholieke Universiteit Leuven, Leuven, Belgium.,Department of Development and Regeneration, Katholieke Universiteit Leuven, Leuven, Belgium
| | - DieuMerci Kabasele Betukumesu
- Division of Nephrology, Department of Paediatrics, Faculty of Medicine, University Hospital of Kinshasa, University of Kinshasa, Kinshasa, Democratic Republic of Congo
| | - Agathe Bikupe Nkoy
- Department of Development and Regeneration, Katholieke Universiteit Leuven, Leuven, Belgium.,Division of Nephrology, Department of Paediatrics, Faculty of Medicine, University Hospital of Kinshasa, University of Kinshasa, Kinshasa, Democratic Republic of Congo
| | | | - Pepe Mfutu Ekulu
- Division of Nephrology, Department of Paediatrics, Faculty of Medicine, University Hospital of Kinshasa, University of Kinshasa, Kinshasa, Democratic Republic of Congo
| | - Lambertus P Van den Heuvel
- Department of Development and Regeneration, Katholieke Universiteit Leuven, Leuven, Belgium.,Department of Paediatric Nephrology, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Elena N Levtchenko
- Department of Development and Regeneration, Katholieke Universiteit Leuven, Leuven, Belgium.,Department of Paediatric Nephrology, University Hospitals Leuven, Leuven, Belgium
| | - Veerle Labarque
- Centre for Molecular and Vascular Biology, Department of Cardiovascular Sciences, Katholieke Universiteit Leuven, Leuven, Belgium.,Department of Paediatric Haemato-Oncology, University Hospitals Leuven, Leuven, Belgium
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17
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Roger C, Lionnet F, Mattioni S, Livrozet M, Steichen O, Letavernier E, Hammoudi N, Avellino V, Haymann J. Risk factors for CKD stage II onset in a prospective cohort of homozygous sickle cell adults. Am J Hematol 2021; 96:1147-1155. [PMID: 34111308 DOI: 10.1002/ajh.26264] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 05/31/2021] [Accepted: 06/03/2021] [Indexed: 12/15/2022]
Abstract
Prevalence of renal impairment is increasing with aging in sickle cell anemia (SCA) patients, and is responsible for a high morbidity and mortality. However, sickle cell nephropathy's natural course remains mostly unknown. We conducted a prospective observational cohort study aimed to identify risk factors for CKD stage II in a cohort of SCA patients. Baseline clinical and biological parameters were collected. Renal parameters were updated at each visit. Risk factors were analyzed using the Cox model. Five-hundred and thirty-five SCA patients were included with a median follow-up of 5.33 (IQR:2.10-8.13) years. Median age was 22 (IQR:19-30) years old. Glomerular hyperfiltration was detected in 299 (55.9%) patients, microalbuminuria and macroalbuminuria in 180 (34%) and 67 (12.7%) patients respectively. During follow up, CKD stage II onset was detected in 39 patients (7.3%). Risk factors for CKD stage II after adjustment on baseline eGFR and age were macroalbuminuria HR: 3.89 [95% CI: 1.61;9.43], diastolic blood pressure (DBP) above 70 mm Hg HR: 2.02 [1.02-3.971], LDH (for 100 IU/L increase) HR: 1.28 [1.12;1.48] and tricuspid regurgitation velocity >2.5 m/sec HR: 2.89 [1.20-6.99]. Multivariate analysis also found age as a strong independent risk factor with HR: (per year increase) 1.13 [1.09;1.16] and a 13.3-fold increase above 30 years (p < 0.001). Our results show a high incidence of CKD stage II with aging, with a strong significant risk increase after 30-years-old, and pinpoint baseline DBP, macroalbuminuria and increased LDH as independent risk factors raising the issue of optimal blood pressure targets for SCA patients.
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Affiliation(s)
- Camille Roger
- Service de Néphrologie – CHRU de Lille Université de Lille Lille France
| | - Francois Lionnet
- Sorbonne Université, Department of Internal Medicine centre de référence de la drépanocytose (AP‐HP), Centre Hospitalier Universitaire Tenon, rue de la Chine Paris France
| | - Sarah Mattioni
- Sorbonne Université, Department of Internal Medicine centre de référence de la drépanocytose (AP‐HP), Centre Hospitalier Universitaire Tenon, rue de la Chine Paris France
| | - Marine Livrozet
- Service d'Explorations Fonctionnelles Multidisciplinaires Assistance Publique‐Hôpitaux de Paris (AP‐HP), Hôpital Tenon Paris France
- Sorbonne Université INSERM, UMR_S 1155, AP‐HP Paris France
| | - Olivier Steichen
- Sorbonne Université, Department of Internal Medicine centre de référence de la drépanocytose (AP‐HP), Centre Hospitalier Universitaire Tenon, rue de la Chine Paris France
| | - Emmanuel Letavernier
- Service d'Explorations Fonctionnelles Multidisciplinaires Assistance Publique‐Hôpitaux de Paris (AP‐HP), Hôpital Tenon Paris France
- Sorbonne Université INSERM, UMR_S 1155, AP‐HP Paris France
| | - Nadjib Hammoudi
- Sorbonne Université, Inserm, Institute of Cardiometabolism and Nutrition (ICAN), ACTION Study Group and Department of Cardiology Institute of Cardiology (AP‐HP), Hôpital Pitié‐Salpêtrière, Boulevard de l'hôpital Paris France
| | - Virginie Avellino
- Sorbonne Université, Department of Internal Medicine centre de référence de la drépanocytose (AP‐HP), Centre Hospitalier Universitaire Tenon, rue de la Chine Paris France
| | - Jean‐Philippe Haymann
- Service d'Explorations Fonctionnelles Multidisciplinaires Assistance Publique‐Hôpitaux de Paris (AP‐HP), Hôpital Tenon Paris France
- Sorbonne Université INSERM, UMR_S 1155, AP‐HP Paris France
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Gama RM, Clery A, Griffiths K, Heraghty N, Peters AM, Palmer K, Kibble H, Vincent RP, Sharpe CC, Cairns H, Bramham K. Estimated glomerular filtration rate equations in people of self-reported black ethnicity in the United Kingdom: Inappropriate adjustment for ethnicity may lead to reduced access to care. PLoS One 2021; 16:e0255869. [PMID: 34383841 PMCID: PMC8360513 DOI: 10.1371/journal.pone.0255869] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 07/27/2021] [Indexed: 12/15/2022] Open
Abstract
Assessment in African populations suggest adjustment for ethnicity in estimated glomerular filtration rate (eGFR) equations derived from African Americans lead to overestimation of GFR and failure to determine severity in chronic kidney disease (CKD). However, studies in African Europeans are limited. We aimed to assess accuracy of eGFR equations, with and without ethnicity adjustment compared with measured GFR in people of Black ethnicity in the United Kingdom. Performance of MDRD, CKD-EPI (with and without ethnicity adjustment), Full Age Spectrum (FAS), revised Lund Malmö (LM Revised), and European Kidney Function Consortium (EKFC) eGFR equations were assessed compared to 51Cr-EDTA GFR studies extracted from hospital databases. Participants with albumin <30g/l, liver disease, <18 years, of non-Black or non-White self-reported ethnicity were excluded. Agreement was assessed by bias, precision and 30%-accuracy and was stratified for ethnicity and GFR. 1888 51Cr-EDTA studies were included (Mean age-53.7yrs; 43.6% female; 14.1% Black ethnicity). Compared to White participants, eGFR-MDRD and eGFR-CKD-EPI equations in Black participants significantly overestimated GFR (bias 20.3 and 19.7 ml/min/1.73m2 respectively, p<0.001). Disregarding the ethnicity adjustment significantly improved GFR estimates for Black participants (bias 6.7 and 2.4ml/min/1.73m2 for eGFR-MDRD and eGFR-CKD-EPI respectively, p<0.001). The LM Revised equation had the smallest bias for both White and Black participants (5.8ml and -1.1ml/min/1.73m2 respectively). 30%-accuracy was superior for GFR≥60ml/min/1.73m2 compared to <60ml/min/1.73m2 using eGFR-CKD-EPI equation for both White and Black participants (p<0.001). Multivariate regression methodology with adjustment for age, sex and log(serum creatinine) in the cohort yielded an ethnicity coefficient of 1.018 (95% CI: 1.009-1.027). Overestimation of measured GFR with eGFR equations using ethnicity adjustment factors may lead to reduced CKD diagnosis and under-recognition of severity in people of Black ethnicity. Our findings suggest that ethnicity adjustment for GFR estimation in non-African Americans may not be appropriate for use in people of Black ethnicity in the UK.
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Affiliation(s)
- Rouvick M. Gama
- King’s Kidney Care, King’s College Hospital NHS Foundation Trust, London, United Kingdom
| | - Amanda Clery
- School of Population Health and Environmental Sciences, King’s College London, London, United Kingdom
| | - Kathryn Griffiths
- King’s Kidney Care, King’s College Hospital NHS Foundation Trust, London, United Kingdom
| | - Neil Heraghty
- Department of Nuclear Medicine, King’s College Hospital NHS Foundation Trust, London, United Kingdom
| | - Adrien M. Peters
- Department of Nuclear Medicine, King’s College Hospital NHS Foundation Trust, London, United Kingdom
| | - Kieran Palmer
- King’s Kidney Care, King’s College Hospital NHS Foundation Trust, London, United Kingdom
| | - Henry Kibble
- King’s Kidney Care, King’s College Hospital NHS Foundation Trust, London, United Kingdom
| | - Royce P. Vincent
- Department of Clinical Biochemistry, King’s College Hospital NHS Foundation Trust, London, United Kingdom
| | - Claire C. Sharpe
- Department of Inflammation Biology, School of Immunology and Microbial Sciences, King’s College London, London, United Kingdom
| | - Hugh Cairns
- King’s Kidney Care, King’s College Hospital NHS Foundation Trust, London, United Kingdom
| | - Kate Bramham
- King’s Kidney Care, King’s College Hospital NHS Foundation Trust, London, United Kingdom
- Department of Women and Children’s Health, King’s College London, London, United Kingdom
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Evaluation of glomerular filtration rate using iohexol plasma clearance in critically ill patients with augmented renal creatinine clearance: A single-centre retrospective study. Eur J Anaesthesiol 2021; 38:652-658. [PMID: 33742973 DOI: 10.1097/eja.0000000000001501] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Augmented renal creatinine clearance (ARC) (≥130 ml min-1 1.73 m-2) is frequent in intensive care unit (ICU) patients and may impact patient outcome. OBJECTIVES To compare glomerular filtration rate (GFR) measured with iohexol plasma clearance and creatinine clearance in critically ill patients with augmented renal clearance. DESIGN Single-centre, retrospective study. SETTING French University Hospital ICU from November 2016 to May 2019. PATIENTS Adult patients with augmented renal clearance who had a measurement of iohexol plasma clearance. MAIN OUTCOME MEASURE Agreement between 6 h creatinine clearance (6 h CrCl) and iohexol plasma clearance (GFRio). RESULTS Twenty-nine patients were included. The median 6 h creatinine clearance was 195 [interquartile range (IQR) 162 to 251] ml min-1 1.73 m-2 and iohexol clearance was 133 [117 to 153] ml min-1 1.73 m-2. Sixteen patients (55%) had hyperfiltration (clearance >130 ml min-1 1.73 m-2) measured with iohexol clearance. Mean bias between iohexol and creatinine clearance was -80 [limits of agreement (LoA) -216 to 56 ml min-1 1.73 m-2]. For Cockcroft and Gault Modification of Diet in Renal Disease equation (MDRD), Chronic Kidney Disease Epidemiology Collaboration equation (CKD-EPI) formulae, mean biases were, respectively -27 (LoA -99 to 45), -14 (LoA -86 to 59) and 15 (LoA -33 to 64) ml min-1 1.73 m-2. CONCLUSION In the present study, we found that in patients with augmented renal creatinine clearance, half of the patients do not have hyperfiltration using iohexol clearance measurements. We observed an important bias between 6 h CrCl and GFRio with large LoA. In critically patients with ARC, 6 h CrCl does not reliably estimate GFR and 6 h CrCl nearly systematically overestimates renal function. Comparison of creatinine-based GFR estimations and GFRio show acceptable bias but wide LoA.
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Olaniran KO, Allegretti AS, Zhao SH, Nigwekar SU, Kalim S. Acute Kidney Injury among Black Patients with Sickle Cell Trait and Sickle Cell Disease. Clin J Am Soc Nephrol 2021; 16:348-355. [PMID: 33648973 PMCID: PMC8011026 DOI: 10.2215/cjn.06960520] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 01/08/2021] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND OBJECTIVES Sickle cell trait and sickle cell disease are associated with faster GFR decline compared with normal hemoglobin phenotypes. We sought to compare the AKI risk in sickle cell trait/disease to normal hemoglobin phenotypes and investigate the association between AKI and GFR decline in sickle cell trait/disease. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS This multicenter observational study used registry data (January 2005-June 2018) of adult Black patients with sickle cell trait/disease (exposures) and normal hemoglobin phenotype (reference) ascertained by hemoglobin electrophoresis. Outcomes of interest (incident AKI [1.5 times baseline serum creatinine or higher], incident severe AKI [doubling of baseline serum creatinine or higher], and incident sustained AKI [AKI persisting for ≥72 hours]) were adjudicated by chart review and evaluated by Cox regression. The association between AKI and GFR decline (linear mixed models) was also investigated. RESULTS We identified 8968 reference patients, 1279 patients with sickle cell trait, and 254 patients with sickle cell disease with a median follow-up of 7.6 years and mean baseline serum creatinine of 0.8 mg/dl. We observed 796 AKI events, 452 sustained AKI events, and 466 severe AKI events. Compared with people with a normal hemoglobin phenotype, sickle cell trait was associated with higher risk for sustained AKI (adjusted hazard ratio, 1.64; 95% confidence interval, 1.27 to 2.11), but not AKI (adjusted hazard ratio, 1.11; 95% confidence interval, 0.91 to 1.36) or severe AKI (adjusted hazard ratio, 1.26; 95% confidence interval, 0.96 to 1.64). Sickle cell disease was associated with AKI (adjusted hazard ratio, 2.85; 95% confidence interval, 2.13 to 3.81), severe AKI (adjusted hazard ratio, 2.38; 95% confidence interval, 1.65 to 3.42), and sustained AKI (adjusted hazard ratio, 2.50; 95% confidence interval, 1.68 to 3.71). Post-AKI GFR decline was significantly faster in sickle cell trait (0.37 ml/min per 1.73 m2 per year faster, P<0.01) and disease (1.69 ml/min per 1.73 m2 per year faster, P<0.01) compared with the reference. CONCLUSIONS Sickle cell trait and disease are associated with higher risk of AKI, which is associated with accelerated decline in eGFR.
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Affiliation(s)
- Kabir O. Olaniran
- 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
| | - 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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Suliman MA, Hassan AM, Kaddam LA. Association between renal function parameters, clinical severity score and mortality risk among adult Sudanese sickle anemia patients. AMERICAN JOURNAL OF BLOOD RESEARCH 2020; 10:434-439. [PMID: 33489452 PMCID: PMC7811912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 11/06/2020] [Indexed: 06/12/2023]
Abstract
BACKGROUND Sickle Cell Anemia (SCA) is an autosomal recessive haemoglobinopathy with high morbidity and mortality. Global survival of sickle patients is increased due to advances in management; and subsequently, prevalence of chronic complications including renal manifestations also increased. Therefore, early detection and management of these complications is mandatory. This study aimed to investigate the estimated Glomerular Filtration Rate (eGFR), proteinuria and serum uric acid as markers of renal involvement in Sudanese sickle adults and association between these parameters and clinical severity score of sickle cell disease. METHODS Cross-sectional hospital-based study included thirty-two adult Sudanese patients diagnosed with SCA and twenty-three as controls. Written informed consent was obtained from each participant. Blood and urine samples were collected. Severity score was calculated using Bios online calculator and eGFR was calculated using Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) formula without adjustment for ethnicity. Associations between the severity score and renal parameters were tested using unpaired T test and Mann Whitney test for normally and non-normally distributed data and correlations between variables were tested using SPSS version 23. RESULTS Protein/Creatinine Ratio (PCR) was significantly higher (p-value < 0.001) in sickle cell anaemia group compared to controls. Hyper-filtration and Hyperuricemia were manifested in 75% and 6.3% of SCA group respectively. There was no association between the severity score and renal manifestations in the SCA group. CONCLUSIONS Hyper-filtration and proteinuria were the most prevalent renal manifestations in SCA group. Further studies are recommended to determine the predictors of renal complications and ensure early management of such complications.
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Affiliation(s)
- Mohamed Ao Suliman
- Department of Physiology, Faculty of Medicine, Al Neelain University Khartoum, Sudan
| | - Alnazeer Ma Hassan
- Department of Physiology, Faculty of Medicine, Al Neelain University Khartoum, Sudan
| | - Lamis A Kaddam
- Department of Physiology, Faculty of Medicine, Al Neelain University Khartoum, Sudan
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Potential causal role of l-glutamine in sickle cell disease painful crises: A Mendelian randomization analysis. Blood Cells Mol Dis 2020; 86:102504. [PMID: 32949984 DOI: 10.1016/j.bcmd.2020.102504] [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: 07/06/2020] [Revised: 09/09/2020] [Accepted: 09/09/2020] [Indexed: 01/12/2023]
Abstract
In a recent clinical trial, the metabolite l-glutamine was shown to reduce painful crises in sickle cell disease (SCD) patients. To support this observation and identify other metabolites implicated in SCD clinical heterogeneity, we profiled 129 metabolites in the plasma of 705 SCD patients. We tested correlations between metabolite levels and six SCD-related complications (painful crises, cholecystectomy, retinopathy, leg ulcer, priapism, aseptic necrosis) or estimated glomerular filtration rate (eGFR), and used Mendelian randomization (MR) to assess causality. We found a potential causal relationship between l-glutamine levels and painful crises (N = 1278, odds ratio (OR) [95% confidence interval] = 0.68 [0.52-0.89], P = 0.0048). In two smaller SCD cohorts (N = 299 and 406), the protective effect of l-glutamine was observed (OR = 0.82 [0.50-1.34]), although the MR result was not significant (P = 0.44). We identified 66 significant correlations between the levels of other metabolites and SCD-related complications or eGFR. We tested these correlations for causality using MR analyses and found no significant causal relationship. The baseline levels of quinolinic acid were associated with prospectively ascertained survival in SCD patients, and this effect was dependent on eGFR. Metabolomics provide a promising approach to prioritize small molecules that may serve as biomarkers or drug targets in SCD.
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23
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Oldham M, Conrey A, Pittman C, Fisher C, Hargrett S, West K, Jackson M, Martin S, Hsieh MM, Jeffries N, Kaplarevic M, Johnson D, Olkhanud P, Fitzhugh CD. Computer Algorithm-Based Hydroxyurea Dosing Facilitates Titration to Maximum Tolerated Dose in Sickle Cell Anemia. J Clin Pharmacol 2020; 61:41-51. [PMID: 32673439 DOI: 10.1002/jcph.1699] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 06/22/2020] [Indexed: 12/15/2022]
Abstract
Adults with sickle cell disease (SCD) experience acute and chronic complications and die prematurely. When taken at maximum tolerated dose (MTD), hydroxyurea prolongs survival; however, it has not consistently reversed organ dysfunction. Patients also frequently do not take hydroxyurea, at least in part because of physician discomfort with prescribing hydroxyurea. We sought to develop a computer program that could easily titrate hydroxyurea to MTD. This was a single-arm, open-label pilot study. Fifteen patients with homozygous SCD were enrolled in the protocol, and 10 patients were followed at baseline and then for 1 year after hydroxyurea initiation or dose titration. Fetal hemoglobin significantly increased in all 10 patients from 8.3% to 25.1% (P < .001). Nine patients were titrated to MTD in an average of 7.9 months, and the tenth patient's hydroxyurea dose was increased to 33 mg/kg/day. Computer program dosing recommendations were the same as manual dosing decisions made using the same algorithm for all patients and at all times. We also evaluated markers of cardiopulmonary, liver and renal damage. Although cardiopulmonary function did not significantly improve, direct bilirubin and alanine aminotransferase levels significantly decreased (P < .001 and P < .01, respectively). Last, although kidney function did not improve, degree of proteinuria was significantly reduced (P < .05). We have developed a computer program that reliably titrates hydroxyurea to MTD. A larger study is indicated to test the program either as a computer program or a downloadable application.
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Affiliation(s)
| | - Anna Conrey
- Sickle Cell Branch, NHLBI, NIH, Bethesda, Maryland, USA
| | | | | | | | - Kamille West
- Department of Transfusion Medicine, Clinical Center, NIH, Bethesda, Maryland, USA
| | - Mary Jackson
- Sickle Cell Branch, NHLBI, NIH, Bethesda, Maryland, USA
| | - Staci Martin
- Pediatric Oncology Branch, NCI, NIH, Bethesda, Maryland, USA
| | | | - Neal Jeffries
- Office of Biostatistics Research, NHLBI, NIH, Bethesda, Maryland, USA
| | | | - Dachelle Johnson
- Pharmacy Department, Clinical Center, NIH, Bethesda, Maryland, USA
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24
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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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25
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Denoix E, Bomahou C, Clavier L, Ribeil JA, Lionnet F, Bartolucci P, Courbebaisse M, Pouchot J, Arlet JB. Primary Hyperparathyroidism in Sickle Cell Disease: An Unknown Complication of the Disease in Adulthood. J Clin Med 2020; 9:jcm9020308. [PMID: 31979085 PMCID: PMC7073651 DOI: 10.3390/jcm9020308] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2019] [Revised: 01/12/2020] [Accepted: 01/20/2020] [Indexed: 12/13/2022] Open
Abstract
Primary hyperparathyroidism (pHPT) is the third most common endocrine disorder and usually affects patients between 60 and 70 years of age. To our knowledge, this condition has never been studied in young patients with sickle cell disease (SCD). Our objective was to describe the clinical and biological characteristics of pHPT in adult patients with SCD and its management. We conducted a retrospective study that included SCD patients who were diagnosed with pHPT in four SCD referral centers. pHPT was defined by the presence of elevated serum calcium levels with inappropriate normal or increased parathyroid hormone (PTH) serum levels or histopathological evidence of parathyroid adenoma or hyperplasia. Patients with severe renal impairment (GFR <30 mL/min) were excluded. Twenty-eight patients (18 women, 64%; 22 homozygous genotype, 79%) were included. The median age at pHPT diagnosis was 41 years (interquartile range -IQR- 31.5-49.5). The median serum calcium and PTH concentration were, respectively, 2.62 mmol/L (IQR 2.60-2.78) and 105 pg/mL (IQR 69-137). Bone mineral density (BMD) revealed very low BMD (-2.5 SD) in 44% of patients explored (vs. 12.5% among 32 SCD patients matched for SCD genotype, sex, age, and BMI, p = 0.03). Fourteen patients (50%) received surgical treatment, which was successful in all cases, but four of these patients (29%) presented with pHPT recurrence after a median time of 6.5 years. Three of these patients underwent a second cervical surgery that confirmed the presence of a new parathyroid adenoma. These results suggest that SCD is a condition associated with pHPT in young subjects. SCD patients with pHPT have a high risk of very low BMD. A diagnosis of pHPT should be suspected in the presence of mild hypercalcemia or low BMD in SCD patients.
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Affiliation(s)
- Elsa Denoix
- Internal Medicine Department, Sickle Cell Referral Center, Georges Pompidou European Hospital, Assistance Publique-Hôpitaux de Paris, 20 rue Leblanc, 75015 Paris, France; (E.D.); (C.B.); (J.P.)
- Faculté de Médecine Paris Descartes, Université de Paris, 75015 Paris, France; (J.-A.R.); (M.C.)
| | - Charlène Bomahou
- Internal Medicine Department, Sickle Cell Referral Center, Georges Pompidou European Hospital, Assistance Publique-Hôpitaux de Paris, 20 rue Leblanc, 75015 Paris, France; (E.D.); (C.B.); (J.P.)
- Faculté de Médecine Paris Descartes, Université de Paris, 75015 Paris, France; (J.-A.R.); (M.C.)
| | - Lorraine Clavier
- Service de Diabétologie-Endocrinologie, Hôpitaux Universitaires Henri Mondor-Albert Chenevier, Assistance Publique-Hôpitaux de Paris, Université Paris-Est Créteil, 94010 Creteil, France;
| | - Jean-Antoine Ribeil
- Faculté de Médecine Paris Descartes, Université de Paris, 75015 Paris, France; (J.-A.R.); (M.C.)
- Laboratory of Excellence GR-Ex, 75015 Paris, France
- Biotherapy Department, Sickle Cell Referral Center, Necker Children’s Hospital, Assistance Publique-Hôpitaux de Paris, 75015 Paris, France
| | - François Lionnet
- Service de Médecine Interne, Sickle Cell Referral Center, Hôpital Tenon (AP-HP), 4, rue de la Chine, 75020 Paris, France;
| | - Pablo Bartolucci
- Sickle Cell Referral Center, Hôpitaux Universitaires Henri Mondor-Albert Chenevier, Assistance Publique-Hôpitaux de Paris, Université Paris-Est Créteil, 94010 Creteil, France;
- Institut Mondor de Recherche Biomédicale (IMRB), Institut National de la Santé et de le Recherche Médicale (INSERM) U955, DHU A-TVB, F-94010 Créteil, France
| | - Marie Courbebaisse
- Faculté de Médecine Paris Descartes, Université de Paris, 75015 Paris, France; (J.-A.R.); (M.C.)
- Physiology Department, Georges Pompidou European Hospital, Assistance Publique-Hôpitaux de Paris, 75015 Paris, France
| | - Jacques Pouchot
- Internal Medicine Department, Sickle Cell Referral Center, Georges Pompidou European Hospital, Assistance Publique-Hôpitaux de Paris, 20 rue Leblanc, 75015 Paris, France; (E.D.); (C.B.); (J.P.)
- Faculté de Médecine Paris Descartes, Université de Paris, 75015 Paris, France; (J.-A.R.); (M.C.)
| | - Jean-Benoît Arlet
- Internal Medicine Department, Sickle Cell Referral Center, Georges Pompidou European Hospital, Assistance Publique-Hôpitaux de Paris, 20 rue Leblanc, 75015 Paris, France; (E.D.); (C.B.); (J.P.)
- Faculté de Médecine Paris Descartes, Université de Paris, 75015 Paris, France; (J.-A.R.); (M.C.)
- Laboratory of Excellence GR-Ex, 75015 Paris, France
- Correspondence: ; Tel.: +33-1-56-09-33-31; Fax: +33-1-56-09-38-16
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26
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Primary Hyperparathyroidism in Sickle Cell Disease: An Unknown Complication of the Disease in Adulthood. J Clin Med 2020. [PMID: 31979085 DOI: 10.3390/jcm9020308.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Primary hyperparathyroidism (pHPT) is the third most common endocrine disorder and usually affects patients between 60 and 70 years of age. To our knowledge, this condition has never been studied in young patients with sickle cell disease (SCD). Our objective was to describe the clinical and biological characteristics of pHPT in adult patients with SCD and its management. We conducted a retrospective study that included SCD patients who were diagnosed with pHPT in four SCD referral centers. pHPT was defined by the presence of elevated serum calcium levels with inappropriate normal or increased parathyroid hormone (PTH) serum levels or histopathological evidence of parathyroid adenoma or hyperplasia. Patients with severe renal impairment (GFR <30 mL/min) were excluded. Twenty-eight patients (18 women, 64%; 22 homozygous genotype, 79%) were included. The median age at pHPT diagnosis was 41 years (interquartile range -IQR- 31.5-49.5). The median serum calcium and PTH concentration were, respectively, 2.62 mmol/L (IQR 2.60-2.78) and 105 pg/mL (IQR 69-137). Bone mineral density (BMD) revealed very low BMD (-2.5 SD) in 44% of patients explored (vs. 12.5% among 32 SCD patients matched for SCD genotype, sex, age, and BMI, p = 0.03). Fourteen patients (50%) received surgical treatment, which was successful in all cases, but four of these patients (29%) presented with pHPT recurrence after a median time of 6.5 years. Three of these patients underwent a second cervical surgery that confirmed the presence of a new parathyroid adenoma. These results suggest that SCD is a condition associated with pHPT in young subjects. SCD patients with pHPT have a high risk of very low BMD. A diagnosis of pHPT should be suspected in the presence of mild hypercalcemia or low BMD in SCD patients.
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27
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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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Comparison between Adult Patients with Sickle Cell Disease of Sub-Saharan African Origin Born in Metropolitan France and in Sub-Saharan Africa. J Clin Med 2019; 8:jcm8122173. [PMID: 31835320 PMCID: PMC6947353 DOI: 10.3390/jcm8122173] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Revised: 12/03/2019] [Accepted: 12/04/2019] [Indexed: 02/02/2023] Open
Abstract
Sickle cell disease (SCD) prevalence has increased rapidly in Europe as a result of an increase in the life expectancy of these patients and the arrival of SCD migrants from Africa. The aim of our study was to compare the phenotypes of adult patients born in Sub-Saharan Africa (SSA) who migrated to France with those of patients with the same origin who were born in France. This single-center observational study compared the demographic, clinical and biological characteristics of SCD adult patients of SSA origin who were born in France or SSA. Data were collected from computerized medical charts. Groups were compared using multivariate logistic regression with adjustment for age, gender and type of SCD. Of the 323 SCD patients followed in our center, 235 were enrolled, including 111 patients born in France and 124 patients born in SSA. SCD genotypes were balanced between groups. Patients born in Africa were older (median age 32.1 (24.4-39) vs. 25.6 (22.1-30.5) years, p < 0.001) and more often women (n = 75 (60.5%) vs. 48 (43.2%), p = 0.008). The median age at arrival in France was 18 years (13-23). The median height was lower among patients born in SSA (169 (163-175) vs. 174.5 cm (168-179), p < 0.001). Over their lifetimes, patients born in France had more acute chest syndromes (median number 2 (1-4) vs. 1 (0-3), p = 0.002), with the first episode occurring earlier (19 (11.6-22.3) vs. 24 (18.4-29.5) years, p < 0.007), and were admitted to intensive care units more often (53.3% vs. 34.9%, p = 0.006). This difference was more pronounced in the SS/Sβ0 population. Conversely, patients born in SSA had more skin ulcers (19.4% vs. 6.3%, p = 0.03). No significant differences were found in social and occupational insertion or other complications between the two groups. Patients born in SSA had a less severe disease phenotype regardless of their age than those born in France. This difference could be related to a survival bias occurring in Africa during childhood and migration to Europe that selected the least severe phenotypes.
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Belisário AR, da Silva AAS, Silva CVM, de Souza LMG, Wakabayashi EA, Araújo SDA, Simoes-e-Silva AC. Sickle cell disease nephropathy: an update on risk factors and potential biomarkers in pediatric patients. Biomark Med 2019; 13:967-987. [DOI: 10.2217/bmm-2019-0105] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
One of the major chronic complications of sickle cell disease (SCD) is sickle cell nephropathy. The aim of this review is to discuss the pathophysiology, natural history, clinical manifestations, risk factors, biomarkers and therapeutic approaches for sickle cell nephropathy, focusing on studies with pediatric patients. The earliest manifestation of renal disease is an increase in the glomerular filtration rate. A finding that may also be observed in early childhood is microalbuminuria. Nephrin, KIM-1, VGFs, chemokines and renin-angiotensin system molecules have emerged as potential early markers of renal dysfunction in SCD. In regards to a therapeutic approach, renin-angiotensin system inhibitors and angiotensin receptor blockers seem to be effective for the control of albuminuria in adults with SCD, although new studies in children are needed. The precise moment to begin renoprotection in SCD patients who should be treated remains to be determined.
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Affiliation(s)
- André R Belisário
- Centro de Tecidos Biológicos de Minas Gerais, Fundação Hemominas, Rua das Goiabeiras, 779, Lagoa Santa, Minas Gerais 33400-000, Brazil
- Laboratório Interdisciplinar de Investigação Médica, Faculdade de Medicina, Universidade Federal de Minas Gerais (UFMG), Av Prof. Alfredo Balena, 190, Belo Horizonte, Minas Gerais 30130-100, Brazil
| | - Ariadna AS da Silva
- Laboratório Interdisciplinar de Investigação Médica, Faculdade de Medicina, Universidade Federal de Minas Gerais (UFMG), Av Prof. Alfredo Balena, 190, Belo Horizonte, Minas Gerais 30130-100, Brazil
| | - Cristiane VM Silva
- Laboratório Interdisciplinar de Investigação Médica, Faculdade de Medicina, Universidade Federal de Minas Gerais (UFMG), Av Prof. Alfredo Balena, 190, Belo Horizonte, Minas Gerais 30130-100, Brazil
| | - Larissa MG de Souza
- Laboratório Interdisciplinar de Investigação Médica, Faculdade de Medicina, Universidade Federal de Minas Gerais (UFMG), Av Prof. Alfredo Balena, 190, Belo Horizonte, Minas Gerais 30130-100, Brazil
| | - Eduarda A Wakabayashi
- Laboratório Interdisciplinar de Investigação Médica, Faculdade de Medicina, Universidade Federal de Minas Gerais (UFMG), Av Prof. Alfredo Balena, 190, Belo Horizonte, Minas Gerais 30130-100, Brazil
| | - Stanley de A Araújo
- Laboratório Interdisciplinar de Investigação Médica, Faculdade de Medicina, Universidade Federal de Minas Gerais (UFMG), Av Prof. Alfredo Balena, 190, Belo Horizonte, Minas Gerais 30130-100, Brazil
| | - Ana C Simoes-e-Silva
- Laboratório Interdisciplinar de Investigação Médica, Faculdade de Medicina, Universidade Federal de Minas Gerais (UFMG), Av Prof. Alfredo Balena, 190, Belo Horizonte, Minas Gerais 30130-100, Brazil
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Menet A, Ranque B, Diop IB, Kingue S, N'guetta R, Diarra M, Diallo D, Diop S, Diagne I, Sanogo I, Chelo D, Wamba G, Deme-Ly I, Faye BF, Seck M, Tolo A, Boidy K, Koffi G, Abough EC, Diakite CO, Traore Y, Legueun G, Kamara I, Offredo L, Marechaux S, Mirabel M, Jouven X. Subclinical Cardiac Dysfunction Is Associated With Extracardiac Organ Damages. Front Med (Lausanne) 2018; 5:323. [PMID: 30525039 PMCID: PMC6262341 DOI: 10.3389/fmed.2018.00323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2018] [Accepted: 10/31/2018] [Indexed: 12/02/2022] Open
Abstract
Background: Several studies conducted in America or Europe have described major cardiac remodeling and diastolic dysfunction in patients with sickle cell disease (SCD). We aimed at assessing cardiac involvement in SCD in sub-Saharan Africa where SCD is the most prevalent. Methods: In Cameroon, Mali and Senegal, SCD patients and healthy controls of the CADRE study underwent transthoracic echocardiography if aged ≥10 years. The comparison of clinical and echocardiographic features between patients and controls, and the associations between echocardiographic features and the vascular complications of SCD were assessed. Results: 612 SCD patients (483 SS or Sβ0, 99 SC, and 19 Sβ+) and 149 controls were included. The prevalence of dyspnea and congestive heart failure was low and did not differ significantly between patients and controls. While left ventricular ejection fraction did not differ between controls and patients, left and right cardiac chambers were homogeneously more dilated and hypertrophic in patients compared to controls and systemic vascular resistances were lower (p < 0.001 for all comparisons). Three hundred and forty nine SCD patients had extra-cardiac organ damages (stroke, leg ulcer, priapism, microalbuminuria or osteonecrosis). Increased left ventricular mass index, cardiac dilatation, cardiac output, and decreased systemic vascular resistances were associated with a history of at least one SCD-related organ damage after adjustment for confounders. Conclusions: Cardiac dilatation, cardiac output, left ventricular hypertrophy, and systemic vascular resistance are associated with extracardiac SCD complications in patients from sub-Saharan Africa despite a low prevalence of clinical heart failure. The prognostic value of cardiac subclinical involvement in SCD patients deserves further studies.
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Affiliation(s)
- Aymeric Menet
- Cardiology unit, Groupement des Hôpitaux de L'université Catholique de Lille, Université Catholique de Lille, Lille, France
| | - Brigitte Ranque
- Internal Medicine Unit, Hôpital Européen Georges Pompidou, Assistance Publique des Hôpitaux de Paris and UMR_S970, Universite Paris Descartes, Inserm, Paris, France
| | | | | | | | - Mamadou Diarra
- Cardiology Unit, Centre Gynéco-obstétrique, Bamako, Mali
| | - Dapa Diallo
- Centre de Recherche et Lutte contre la Drépanocytose, Bamako, Mali
| | - Saliou Diop
- Centre National de Transfusion Sanguine, Dakar, Senegal
| | - Ibrahima Diagne
- Pediatrics Unit, Centre Hospitalier National d'Enfants Albert Royer de Dakar, Université Cheikh Anta Diop, Dakar, Senegal
| | | | - David Chelo
- Cardiology Unit, Fondation Mère Enfant Chantal Biya, Yaoundé, Cameroon
| | - Guillaume Wamba
- Pediatrics Unit, Centre Hospitalier d'Essos, Yaoundé, Cameroon
| | - Indou Deme-Ly
- Pediatrics Unit, Centre Hospitalier National d'Enfants Albert Royer de Dakar, Université Cheikh Anta Diop, Dakar, Senegal
| | | | - Moussa Seck
- Centre National de Transfusion Sanguine, Dakar, Senegal
| | - Aissata Tolo
- Hematology Unit, CHU de Yopougon, Abidjan, Ivory Coast
| | - Kouakou Boidy
- Hematology Unit, CHU de Yopougon, Abidjan, Ivory Coast
| | - Gustave Koffi
- Hematology Unit, CHU de Yopougon, Abidjan, Ivory Coast
| | | | | | - Youssouf Traore
- Centre de Recherche et Lutte contre la Drépanocytose, Bamako, Mali
| | | | - Ismael Kamara
- Hematology Unit, CHU de Yopougon, Abidjan, Ivory Coast
| | - Lucile Offredo
- UMR_S970, Université Paris Descartes, Inserm, Paris, France
| | - Sylvestre Marechaux
- Cardiology unit, Groupement des Hôpitaux de L'université Catholique de Lille, Université Catholique de Lille, Lille, France
| | - Mariana Mirabel
- Cardiology Department, Hôpital Européen Georges Pompidou, Assistance Publique des Hôpitaux de Paris and UMR_S970, Université Paris Descartes, Inserm, Paris, France
| | - Xavier Jouven
- Cardiology Department, Hôpital Européen Georges Pompidou, Assistance Publique des Hôpitaux de Paris and UMR_S970, Université Paris Descartes, Inserm, Paris, France
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Xu JZ, Garrett ME, Soldano KL, Chen ST, Clish CB, Ashley-Koch AE, Telen MJ. Clinical and metabolomic risk factors associated with rapid renal function decline in sickle cell disease. Am J Hematol 2018; 93:1451-1460. [PMID: 30144150 DOI: 10.1002/ajh.25263] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Revised: 08/16/2018] [Accepted: 08/20/2018] [Indexed: 12/22/2022]
Abstract
Sickle cell disease (SCD) nephropathy and lower estimated glomerular filtration rate (eGFR) are risk factors for early mortality. Furthermore, rate of eGFR decline predicts progression to end-stage renal disease in many clinical settings. However, factors predicting renal function decline in SCD are poorly documented. Using clinical, laboratory, genetic, and metabolomic data, we evaluated predictors of renal function decline in a longitudinal cohort of 288 adults (mean age 33.0 years). In 193 subjects with 5-year follow-up data, mean rate of eGFR decline was 2.35 mL/min/1.73 m2 /year, nearly twice that of African American adults overall. Hyperfiltration was prevalent at baseline (61.1%), and 36.8% of subjects experienced rapid eGFR decline (≥3 mL/min/1.73 m2 /year). Severe Hb genotype; proteinuria; higher platelet and reticulocyte counts, and systolic BP; and lower Hb level and BMI were associated with rapid decline. A risk scoring system was created using these 7 variables and was highly predictive of rapid eGFR decline, with odds of rapid decline increasing 1.635-fold for every point increment (P < 0.0001). Rapid eGFR decline was also associated with higher organ system severity score and peak creatinine. Additionally, two metabolites (asymmetric dimethylarginine and quinolinic acid) were associated with rapid decline. Further investigation into longitudinal SCD nephropathy (SCDN) trajectory, early markers of SCDN, and tools for risk stratification should inform interventional studies targeted to slowing GFR decline and improving SCD outcomes.
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Affiliation(s)
- Julia Z Xu
- Department of Medicine, Duke University Medical Center, Durham, North Carolina
| | - Melanie E Garrett
- Department of Medicine, Division of Nephrology and Duke Molecular Physiology Institute, Duke University Medical Center, Durham, North Carolina
| | - Karen L Soldano
- Department of Medicine, Division of Nephrology and Duke Molecular Physiology Institute, Duke University Medical Center, Durham, North Carolina
| | - Sean T Chen
- Duke University School of Medicine, Durham, North Carolina
| | - Clary B Clish
- Metabolite Profiling, Broad Institute, Massachusetts Institute of Technology and Harvard University, Cambridge, Massachusetts
| | - Allison E Ashley-Koch
- Department of Medicine, Division of Nephrology and Duke Molecular Physiology Institute, Duke University Medical Center, Durham, North Carolina
| | - Marilyn J Telen
- Department of Medicine, Division of Hematology and Duke Comprehensive Sickle Cell Center, Duke University Medical Center, Durham, North Carolina
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Pinto GG, Poloni JAT, Paskulin DD, Spuldaro F, Paris FD, Barth AL, Manfro RC, Keitel E, Pasqualotto AC. Quantitative detection of BK virus in kidney transplant recipients: a prospective validation study. ACTA ACUST UNITED AC 2018; 40:59-65. [PMID: 29796578 PMCID: PMC6533964 DOI: 10.1590/1678-4685-jbn-3776] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2017] [Accepted: 05/18/2017] [Indexed: 11/21/2022]
Abstract
Introduction: BK virus (BKV) infection in renal transplant patients may cause kidney
allograft dysfunction and graft loss. Accurate determination of BKV viral
load is critical to prevent BKV-associated nephropathy (BKVAN) but the
cut-off that best predicts BKVAN remains controversial. Objective: To evaluate the performance of a commercial and an in-house qPCR test for
quantitative detection of BK virus in kidney transplant recipients. Methods: This was a prospective study with kidney transplant recipients from two large
university hospitals in Brazil. Patients were screened for BKV infection
every 3 months in the first year post-transplant with a commercial and an
in-house real time polymerase chain reaction (qPCR) test. BKVAN was
confirmed based on histopathology. The area under the curve for plasma qPCR
was determined from receiver operating characteristic analysis. Results: A total of 200 patients were enrolled. Fifty-eight percent were male, 19.5%
had diabetes mellitus, and 82% had the kidney transplanted from a deceased
donor. BKV viremia was detected in 32.5% and BKVAN was diagnosed in 8
patients (4%). BKVAN was associated with viremia of 4.1 log copies/mL, using
a commercial kit. The cut-off for the in-house assay was 6.1 log copies/mL.
The linearity between the commercial kit and the in-house assay was
R2=0.83. Conclusion: Our study shows that marked variability occurs in BKV viral load when
different qPCR methodologies are used. The in-house qPCR assay proved
clinically useful, a cheaper option in comparison to commercial qPCR kits.
There is an urgent need to make BKV standards available to the international
community.
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Affiliation(s)
| | - José Antonio Tesser Poloni
- Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Brasil.,Santa Casa de Misericórdia de Porto Alegre, Porto Alegre, Brasil
| | | | - Fabio Spuldaro
- Hospital de Clínicas de Porto Alegre, Porto Alegre, Brasil
| | | | | | | | - Elizete Keitel
- Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Brasil.,Santa Casa de Misericórdia de Porto Alegre, Porto Alegre, Brasil
| | - Alessandro C Pasqualotto
- Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Brasil.,Santa Casa de Misericórdia de Porto Alegre, Porto Alegre, Brasil
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Garba M, Moussa Tondi ZM, Diongoule H, Aboubacar S, Ide A, Biyao-Nelson NR, Soumaila I, Alido S. [Screening for nephropathy in major sickle cell syndromes in patients monitored at the National Reference Center for Sickle Cell Disease in Niamey, Niger]. Nephrol Ther 2018; 14:462-466. [PMID: 29311011 DOI: 10.1016/j.nephro.2017.11.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Revised: 11/04/2017] [Accepted: 11/07/2017] [Indexed: 12/13/2022]
Abstract
BACKGROUND Sickle cell anemia is the most common hereditary hemopathy in the world. It is a disease that attacks all the systems of the organism. The kidneys are among the most sensitive organs of this disease. The main objective of this study is to detect sickle cell nephropathy in patients followed at the National Reference Center for Sickle Cell Disease in Niamey. METHODS It is a prospective study carried out over a period of one year (January to December 2016). It included patients aged at least two years who had not had a vaso-occlusive crisis (VOC) for 2 months and not transfused for at least 3 months. A questionnaire was sent to each patient to collect demographic, clinical and biological information. Each patient provided a fresh blood and urine sample to assess biological parameters. We used Schwartz's formula in children and CKD-EPI in adults to assess glomerular filtration rate. The Pearson correlation coefficient (r) was used to assess the relationship between the different parameters under study. The threshold for statistical significance was set at 0.05. RESULTS Two hundred and eighty participants were included in the study. Adolescents (≤17years) were 226 (80.71%) and adults were 54 (19.29%). The mean age of the patients was 11.94±4.70years. It was lower in SS subjects and higher in SC. The SS form accounted for 87.5% of the three sickle cell disease phenotypes encountered. The age group 6-15years was the most predominant (42.86%). The mean baseline hemoglobin in the sample was 7.59±1.15g/dL ; (6.8 ±0.9d/dL) in SS patients and higher (10.5±2.1g/dL) in SC patients. The average glomerular filtration rate was 201.04mL/min/1.73m2. Glomerular hyperfiltration was found in 90% of the sample, it was lower (77.6%) in Sβ thalassemia patients (P=0.000). In young subjects hyperfiltration was present in 84.95% against it was observed in only 29.63% of adults. Proteinuria was positive in 20% of patients. Positive proteinuria was found in 6.20% pediatric cases. The SC form was the most affected and in 74.6% of the patients it was positive at 1+. Chronic kidney disease (CKD) was found in 10% of the participants, of whom 75% were of the SS phenotype. Sβ thalassemia subjects had no CKD. The male sex was predominant in subjects with CKD (P=0.000). Patients over 15 years of age accounted for more than 95% of patients in both forms of the disease (P=0.0001). CONCLUSION The SS form of the disease, recurrent vaso-occlusive crisis, male sex and advanced age were the main precipitating factors in the development of renal function disorders.
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Affiliation(s)
- Moumouni Garba
- Service de pédiatrie, hôpital national Lamordé, BP 10896, rue 002 Université, Com V, Niamey, Niger.
| | | | - Hassan Diongoule
- Service de néphrologie, hôpital national de Zinder, BP 155, Niger
| | - Samaila Aboubacar
- Service de pédiatrie, hôpital national Lamordé, BP 10896, rue 002 Université, Com V, Niamey, Niger
| | - Abdou Ide
- Service de néphrologie, hôpital national Lamordé, rue 002 Université, Com V, Niamey, Niger
| | | | - Illiassou Soumaila
- Service de néphrologie, hôpital national Lamordé, rue 002 Université, Com V, Niamey, Niger
| | - Soumana Alido
- Service de pédiatrie, hôpital national Lamordé, BP 10896, rue 002 Université, Com V, Niamey, Niger
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Yee MEM, Lane PA, Archer DR, Joiner CH, Eckman JR, Guasch A. Estimation of glomerular filtration rate using serum cystatin C and creatinine in adults with sickle cell anemia. Am J Hematol 2017; 92:E598-E599. [PMID: 28670697 DOI: 10.1002/ajh.24840] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Revised: 06/21/2017] [Accepted: 06/24/2017] [Indexed: 11/06/2022]
Affiliation(s)
- Marianne E. M. Yee
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta; Atlanta Georgia
- Division of Hematology/Oncology; Department of Pediatrics, Emory University School of Medicine; Atlanta Georgia
| | - Peter A. Lane
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta; Atlanta Georgia
- Division of Hematology/Oncology; Department of Pediatrics, Emory University School of Medicine; Atlanta Georgia
| | - David R. Archer
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta; Atlanta Georgia
- Division of Hematology/Oncology; Department of Pediatrics, Emory University School of Medicine; Atlanta Georgia
| | - Clinton H. Joiner
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta; Atlanta Georgia
- Division of Hematology/Oncology; Department of Pediatrics, Emory University School of Medicine; Atlanta Georgia
| | - James R. Eckman
- Department of Hematology and Oncology; Winship Cancer Institute, Emory University School of Medicine; Atlanta Georgia
| | - Antonio Guasch
- Department of Medicine; Renal Division, Emory University School of Medicine; Atlanta Georgia
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Degree of anemia, indirect markers of hemolysis, and vascular complications of sickle cell disease in Africa. Blood 2017; 130:2215-2223. [PMID: 28931524 DOI: 10.1182/blood-2016-12-755777] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Accepted: 09/02/2017] [Indexed: 11/20/2022] Open
Abstract
The hyperhemolysis paradigm that describes overlapping "hyperhemolytic-endothelial dysfunction" and "high hemoglobin-hyperviscous" subphenotypes of sickle cell disease (SCD) patients is based on North American studies. We performed a transversal study nested in the CADRE cohort to analyze the association between steady-state hemolysis and vascular complications of SCD among sub-Saharan African patients. In Mali, Cameroon, and Ivory Coast, 2407 SCD patients (1751 SS or sickle β-zero-thalassemia [Sβ0], 495 SC, and 161 sickle β+-thalassemia [Sβ+]), aged 3 years old and over, were included at steady state. Relative hemolytic intensity was estimated from a composite index derived from principal component analysis, which included bilirubin levels or clinical icterus, and lactate dehydrogenase levels. We assessed vascular complications (elevated tricuspid regurgitant jet velocity [TRV], microalbuminuria, leg ulcers, priapism, stroke, and osteonecrosis) by clinical examination, laboratory tests, and echocardiography. After adjustment for age, sex, country, and SCD phenotype, a low hemoglobin level was significantly associated with TRV and microalbuminuria in the whole population and with leg ulcers in SS-Sβ0 adults. A high hemolysis index was associated with microalbuminuria in the whole population and with elevated TRV, microalbuminuria, and leg ulcers in SS-Sβ0 adults, but these associations were no longer significant after adjustment for hemoglobin level. In conclusion, severe anemia at steady state in SCD patients living in West and Central Africa is associated with elevated TRV, microalbuminuria, and leg ulcers, but these vascular complications are not independently associated with indirect markers of increased hemolysis. Other mechanisms leading to anemia, including malnutrition and infectious diseases, may also play a role in the development of SCD vasculopathy.
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Kormann R, Jannot AS, Narjoz C, Ribeil JA, Manceau S, Delville M, Joste V, Prié D, Pouchot J, Thervet E, Courbebaisse M, Arlet JB. Roles of APOL1 G1 and G2 variants in sickle cell disease patients: kidney is the main target. Br J Haematol 2017; 179:323-335. [PMID: 28699644 DOI: 10.1111/bjh.14842] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Accepted: 05/28/2017] [Indexed: 12/29/2022]
Abstract
In African-American patients with sickle cell disease (SCD), APOL1 G1 and G2 variants are associated with increased risk of sickle cell nephropathy (SCN). To determine the role of APOL1 variants in SCD patients living in Europe, we genotyped 152 SCD patients [aged 30·4 (24·3-36·4) years], mainly of Sub-Saharan African ancestry, for APOL1 G1 and G2 and for variants of four genes with kidney tropism (GSTM1, GSTT1, GSTP1, and HMOX1). Homozygous or double-heterozygous APOL G1 and G2 genotypes were strongly associated with end stage renal disease (P = 0·003) and worse Kidney Disease: Improving Global Outcomes stages (P = 0·001). Further, these genotypes were associated in an age-dependent manner with lower estimated glomerular filtration rate (eGFR, P = 0·008), proteinuria (P = 0·009) and albuminuria (P < 0·001) but not with other SCD complications. Compared to APOL1 G1/wild type (WT), the APOL1 G2/WT genotype was associated with a lower eGFR (P = 0·04) in an age-dependent manner, suggesting that the G2/WT patients are likely to have worse kidney prognosis. Other genes variants analysed were not associated with SCN or other SCD complications. Our data indicate that APOL1 screening should be considered for the management of SCD patients, including those of non-African-American origin, as those with homozygous or double heterozygous variants are clearly at higher risk of SCN.
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Affiliation(s)
- Raphaël Kormann
- Physiology Department, Georges Pompidou European Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France.,Paris Descartes Faculty of Medicine, Paris, France
| | - Anne-Sophie Jannot
- Paris Descartes Faculty of Medicine, Paris, France.,INSERM UMR 1138-E22: Information Sciences & Personalized Medicine, Paris, France.,Medical Informatics, Biostatistics and Public Health Department, Georges Pompidou University Hospital, Paris, France
| | - Céline Narjoz
- Paris Descartes Faculty of Medicine, Paris, France.,Biochemistry Department, Georges Pompidou European Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France.,Institut National pour la Santé et la Recherche Médicale (INSERM) UMR-S 1147, Paris, France
| | - Jean-Antoine Ribeil
- Paris Descartes Faculty of Medicine, Paris, France.,Biotherapy Department, Necker Children's Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France.,Biotherapy Clinical Investigation Centre, Groupe Hospitalier Universitaire Ouest, Assistance Publique-Hôpitaux de Paris, INSERM, Paris, France.,Centre de Référence des Syndromes Drépanocytaires Majeurs, Necker-Enfants-Malades University Hospital, APHP, Université Paris 5, Paris, France
| | - Sandra Manceau
- Paris Descartes Faculty of Medicine, Paris, France.,Biotherapy Department, Necker Children's Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Marianne Delville
- Paris Descartes Faculty of Medicine, Paris, France.,Biotherapy Department, Necker Children's Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France.,Centre de Référence des Syndromes Drépanocytaires Majeurs, Necker-Enfants-Malades University Hospital, APHP, Université Paris 5, Paris, France
| | - Valentin Joste
- Paris Descartes Faculty of Medicine, Paris, France.,Biochemistry Department, Georges Pompidou European Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Dominique Prié
- Paris Descartes Faculty of Medicine, Paris, France.,INSERM U1151-CNRS UMR8253, Paris, France.,AP-HP, Necker Children's Hospital, Physiology Department, Paris Descartes University, Paris, France
| | - Jacques Pouchot
- Paris Descartes Faculty of Medicine, Paris, France.,Internal Medicine Department, Sickle Cell Referral Centre, Faculté de Médecine Paris Descartes, Sorbonne Paris-Cité et Assistance Publique-Hôpitaux de Paris, Georges Pompidou University Hospital, Paris, France
| | - Eric Thervet
- Paris Descartes Faculty of Medicine, Paris, France.,Institut National pour la Santé et la Recherche Médicale (INSERM) UMR-S 1147, Paris, France.,Department of Nephrology, Georges Pompidou University Hospital, Assistance Publique- Hôpitaux de Paris, Paris, France
| | - Marie Courbebaisse
- Physiology Department, Georges Pompidou European Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France.,Paris Descartes Faculty of Medicine, Paris, France.,INSERM U1151-CNRS UMR8253, Paris, France
| | - Jean-Benoît Arlet
- Paris Descartes Faculty of Medicine, Paris, France.,Internal Medicine Department, Sickle Cell Referral Centre, Faculté de Médecine Paris Descartes, Sorbonne Paris-Cité et Assistance Publique-Hôpitaux de Paris, Georges Pompidou University Hospital, Paris, France.,Laboratory of Excellence GR-Ex, Paris, France
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Roy NBA, Fortin PM, Bull KR, Doree C, Trivella M, Hopewell S, Estcourt LJ. Interventions for chronic kidney disease in people with sickle cell disease. Cochrane Database Syst Rev 2017; 7:CD012380. [PMID: 28672087 PMCID: PMC5544118 DOI: 10.1002/14651858.cd012380.pub2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Sickle cell disease (SCD) is one of the commonest severe monogenic disorders in the world, due to the inheritance of two abnormal haemoglobin (beta-globin) genes. SCD can cause severe pain, significant end-organ damage, pulmonary complications, and premature death. Kidney disease is a frequent and potentially severe complication in people with SCD.Chronic kidney disease is defined as abnormalities of kidney structure or function, present for more than three months. Sickle cell nephropathy refers to the spectrum of kidney complications in SCD.Glomerular damage is a cause of microalbuminuria and can develop at an early age in children with SCD, and increases in prevalence in adulthood. In people with sickle cell nephropathy, outcomes are poor as a result of the progression to proteinuria and chronic kidney insufficiency. Up to 12% of people who develop sickle cell nephropathy will develop end-stage renal disease. OBJECTIVES To assess the effectiveness of any intervention in preventing or reducing kidney complications or chronic kidney disease in people with SCD (including red blood cell transfusions, hydroxyurea and angiotensin-converting enzyme inhibitor (ACEI)), either alone or in combination with each other. SEARCH METHODS We searched for relevant trials in the Cochrane Library, MEDLINE (from 1946), Embase (from 1974), the Transfusion Evidence Library (from 1980), and ongoing trial databases; all searches current to 05 April 2016. We searched the Cochrane Cystic Fibrosis and Genetic Disorders Group Trials Register: 13 April 2017. SELECTION CRITERIA Randomised controlled trials comparing interventions to prevent or reduce kidney complications or chronic kidney disease in people with SCD. There were no restrictions by outcomes examined, language or publication status. DATA COLLECTION AND ANALYSIS Two authors independently assessed trial eligibility, extracted data and assessed the risk of bias. MAIN RESULTS We included two trials with 215 participants. One trial was published in 2011 and included 193 children aged 9 months to 18 months, and compared treatment with hydroxyurea to placebo. The second trial was published in 1998 and included 22 adults with normal blood pressure and microalbuminuria and compared ACEI to placebo.We rated the quality of evidence as low to very low across different outcomes according to GRADE methodology. This was due to trials having: a high or unclear risk of bias including attrition and detection bias; indirectness (the available evidence was for children aged 9 months to 18 months in one trial and a small and select adult sample size in a second trial); and imprecise outcome effect estimates of significant benefit or harm. Hydroxyurea versus placebo We are very uncertain if hydroxyurea reduces or prevents progression of kidney disease (assessed by change in glomerular filtration rate), or reduces hyperfiltration in children aged 9 to 18 months, mean difference (MD) 0.58 (95% confidence interval (CI) -14.60 to 15.76 (mL/min per 1.73 m²)) (one study; 142 participants; very low-quality evidence).In children aged 9 to 18 months, hydroxyurea may improve the ability to concentrate urine, MD 42.23 (95% CI 12.14 to 72.32 (mOsm/kg)) (one study; 178 participants; low-quality evidence).Hydroxyurea may make little or no difference to SCD-related serious adverse events including: incidence of acute chest syndrome, risk ratio (RR) 0.39 (99% CI 0.13 to 1.16); painful crisis, RR 0.68 (99% CI 0.45 to 1.02); and hospitalisations, RR 0.83 (99% CI 0.68 to 1.01) (one study, 193 participants; low-quality evidence).No deaths occurred in the trial. Quality of life was not reported. ACEI versus placeboWe are very uncertain if ACEI reduces proteinuria in adults with SCD who have normal blood pressure and microalbuminuria, MD -49.00 (95% CI -124.10 to 26.10 (mg per day)) (one study; 22 participants; very low-quality evidence). We are very uncertain if ACEI reduce or prevent kidney disease as measured by creatinine clearance. The authors state that creatinine clearance remained constant over six months in both groups, but no comparative data were provided (very low-quality evidence).All-cause mortality, serious adverse events and quality of life were not reported. AUTHORS' CONCLUSIONS In young children aged 9 months to 18 months, we are very uncertain if hydroxyurea improves glomerular filtration rate or reduces hyperfiltration, but it may improve young children's ability to concentrate urine and may make little or no difference on the incidence of acute chest syndrome, painful crises and hospitalisations.We are very uncertain if giving ACEI to adults with normal blood pressure and microalbuminuria has any effect on preventing or reducing kidney complications.This review identified no trials that looked at red cell transfusions nor any combinations of interventions to prevent or reduce kidney complications.Due to lack of evidence this review cannot comment on the management of either children aged over 18 months or adults with any known genotype of SCD.We have identified a lack of adequately-designed and powered studies, and no ongoing trials which address this critical question. Trials of hydroxyurea, ACEI or red blood cell transfusion in older children and adults are urgently needed to determine any effect on prevention or reduction kidney complications in people with SCD.
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Affiliation(s)
- Noemi BA Roy
- University of OxfordWeatherall Institute of Molecular MedicineJohn Radcliffe HospitalHeadley WayOxfordUKOX3 9DU
| | - Patricia M Fortin
- NHS Blood and TransplantSystematic Review InitiativeJohn Radcliffe HospitalOxfordUKOX3 9BQ
| | - Katherine R Bull
- Oxford University Hospitals Trust and the University of OxfordOxford Kidney Unit and Nuffield Department of MedicineCornall Group, Henry Wellcome Building for Molecular PhysiologyRoosevelt DriveOxfordUKOX3 7BN
| | - Carolyn Doree
- NHS Blood and TransplantSystematic Review InitiativeJohn Radcliffe HospitalOxfordUKOX3 9BQ
| | - Marialena Trivella
- University of OxfordCentre for Statistics in MedicineBotnar Research CentreWindmill RoadOxfordUKOX3 7LD
| | - Sally Hopewell
- University of OxfordOxford Clinical Trials Research UnitNuffield Department of Orthopaedics, Rheumatology and Musculoskeletal SciencesWindmill RoadOxfordOxfordshireUKOX3 7LD
| | - Lise J Estcourt
- NHS Blood and TransplantHaematology/Transfusion MedicineLevel 2, John Radcliffe HospitalHeadingtonOxfordUKOX3 9BQ
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Geard A, Pule GD, Chetcha Chemegni B, Ngo Bitoungui VJ, Kengne AP, Chimusa ER, Wonkam A. Clinical and genetic predictors of renal dysfunctions in sickle cell anaemia in Cameroon. Br J Haematol 2017; 178:629-639. [PMID: 28466968 DOI: 10.1111/bjh.14724] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Accepted: 02/22/2017] [Indexed: 01/08/2023]
Abstract
Micro-albuminuria and glomerular hyperfiltration are primary indicators of renal dysfunctions in Sickle Cell Disease (SCD), with more severe manifestations previously associated with variants in APOL1 and HMOX1 among African Americans. We have investigated 413 SCD patients from Cameroon. Anthropometric variables, haematological indices, crude albuminuria, albumin-to-creatinine ratio (ACR) and estimated glomerular filtration rate (eGFR) were measured. Patients were genotyped for 3·7 kb alpha-globin gene (HBA1/HBA2) deletion, and for variants in APOL1 (G1/G2; rs60910145, rs73885319, rs71785313) and HMOX1 (rs3074372, rs743811). The median age was 15 years; the majority presented with micro-albuminuria (60·9%; n = 248), and approximately half with glomerular hyperfiltration (49·5%; n = 200). Age, male sex, haemoglobin level, leucocyte count, mean corpuscular volume, blood pressure, body mass index and creatinine levels significantly affected albuminuria and/or eGFR. Co-inheritance of alpha-thalassaemia was protective against macro-albuminuria (P = 0·03). APOL1 G1/G2 risk variants were significantly associated with the ACR (P = 0·01) and borderline with eGFR (P = 0·07). HMOX1 - rs743811 was borderline associated with micro-albuminuria (P = 0·07) and macro-albuminuria (P = 0·06). The results revealed a high proportion of micro-albuminuria and glomerular hyperfiltration among Cameroonian SCD patients, and support the possible use of targeted genetic biomarkers for risks assessment.
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Affiliation(s)
- Amy Geard
- Division of Human Genetics, Department of Pathology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Gift D Pule
- Division of Human Genetics, Department of Pathology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | | | | | - Andre P Kengne
- Non-Communicable Diseases Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Emile R Chimusa
- Division of Human Genetics, Department of Pathology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Ambroise Wonkam
- Division of Human Genetics, Department of Pathology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
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39
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Audard V, Bartolucci P, Stehlé T. Sickle cell disease and albuminuria: recent advances in our understanding of sickle cell nephropathy. Clin Kidney J 2017; 10:475-478. [PMID: 28852484 PMCID: PMC5570022 DOI: 10.1093/ckj/sfx027] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Accepted: 02/17/2017] [Indexed: 12/16/2022] Open
Abstract
Albuminuria is considered to be a relevant biomarker for the detection of early glomerular damage in patients with sickle cell disease (SCD). Improvements in our understanding of the pathophysiological processes and molecular mechanisms underlying albuminuria are required, because increasing numbers of patients with SCD are developing chronic kidney disease. The early recognition of sickle cell nephropathy (SCN) and studies of the natural course of this emerging renal disease are therefore crucial, together with identification of the associated clinical and biological risk factors, to make it possible to initiate kidney-protective therapy at early stages of renal impairment. The pathophysiological process underlying SCN remains hypothetical, but chronic haemolysis-related endothelial dysfunction and the relative renal hypoxia triggered by repeated vaso-occlusive crises have been identified as two potential key factors. The optimal preventive and curative management of albuminuria in the context of SCD is yet to be established, but recent studies have suggested that hydroxyurea therapy, the cornerstone of SCD treatment, could play a key role in reducing albuminuria. The place of conventional kidney-protecting measures, such as renin–angiotensin system inhibitors, in the treatment of SCD patients also remains to be determined.
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Affiliation(s)
- Vincent Audard
- Service de Néphrologie et Transplantation, Institut Francilien de Recherche en Néphrologie et Transplantation (IFRNT), Groupe Hospitalier Henri Mondor-Albert Chenevier, Assistance Publique-Hôpitaux de Paris (APHP), Université Paris-Est Créteil (UPEC), Créteil, France.,Unité INSERM U955, Equipe 21, Centre de Référence Syndrome Néphrotique Idiopathique, UPEC, Créteil, France
| | - Pablo Bartolucci
- Centre de Référence des Syndromes Drépanocytaires Majeurs, Groupe Hospitalier Henri Mondor-Albert Chenevier, APHP, UPEC, Créteil, France.,Service de Médecine Interne, Groupe Hospitalier Henri Mondor-Albert Chenevier, APHP, UPEC, Créteil, France.,Unité INSERM 955, Equipe 2 émergente, UPEC, Créteil, France.,Laboratoire of Excellence GR-Ex, Paris, France
| | - Thomas Stehlé
- Service de Néphrologie et Transplantation, Institut Francilien de Recherche en Néphrologie et Transplantation (IFRNT), Groupe Hospitalier Henri Mondor-Albert Chenevier, Assistance Publique-Hôpitaux de Paris (APHP), Université Paris-Est Créteil (UPEC), Créteil, France.,Unité INSERM U955, Equipe 21, Centre de Référence Syndrome Néphrotique Idiopathique, UPEC, Créteil, France
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40
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Delville M, Manceau S, Ait Abdallah N, Stolba J, Awad S, Damy T, Gellen B, Sabbah L, Debbache K, Audard V, Beaumont JL, Arnaud C, Chantalat-Auger C, Driss F, Lefrère F, Cavazzana M, Franco G, Galacteros F, Ribeil JA, Gellen-Dautremer J. Arterio-venous fistula for automated red blood cells exchange in patients with sickle cell disease: Complications and outcomes. Am J Hematol 2017; 92:136-140. [PMID: 27813144 DOI: 10.1002/ajh.24600] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Revised: 10/31/2016] [Accepted: 11/01/2016] [Indexed: 12/11/2022]
Abstract
Erythrocytapheresis (ER) can improve outcome in patients with sickle cell disease (SCD). A good vascular access is required but frequently it can be difficult to obtain for sickle cell patients. Arterio-venous fistulas (AVFs) have been suggested for ER in SCD supported by limited evidence. We report the largest cohort of ER performed with AVFs from three French SCD reference centers. Data of SCD patients undergoing ER with AVFs in the French SCD reference center were retrospectively collected. The inclusion criteria were: SS or Sβ-Thalassemia and AVF surgery for ER. SCD-related complications, transfusion history, details about AVF surgical procedure, echocardiographic data before and after AVF, AVF-related surgical and hemodynamical complications were collected. Twenty-six patients (mean age 20.5 years, mean follow-up 68 months [11-279]) were included. Twenty-three patients (88.5%) required central vascular access before AVF. Fifteen AVFs (58%) were created on the forearm and 11 (42%) on the arm. Nineteen patients (73%) had stenotic, thrombotic or infectious AVF complications. A total of 0.36 stenosis per 1,000 AVF days, 0.37 thrombosis per 1,000 AVF days and 0.078 infections per 1.000 AVF days were observed. The mean AVF lifespan was 51 months [13-218]. One patient with severe pulmonary hypertension worsened after AVF creation and died. We report the first series of SCD patients with AVF for ER, demonstrating that AVFs could be considered as a potential vascular access for ER. Patients with increased risk for hemodynamic intolerance of AVFs must be carefully identified, so that alternative vascular accesses can be considered. Am. J. Hematol. 92:136-140, 2017. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Marianne Delville
- Biotherapy department; Necker-Enfants-Malades-University Hospital, APHP, Université Paris 5; Paris France
- Centre de Référence des Syndromes Drépanocytaires Majeurs, Necker-Enfants-Malades-University Hospital, APHP, Université Paris 5; Paris France
| | - Sandra Manceau
- Biotherapy department; Necker-Enfants-Malades-University Hospital, APHP, Université Paris 5; Paris France
| | - Nassim Ait Abdallah
- Centre de Référence des Syndromes Drépanocytaires Majeurs, Henri Mondor University Hospital, APHP, Université Paris-Est Créteil; France
| | - Jan Stolba
- Vascular surgery department; La Roseraie Clinic; Aubervilliers France
| | - Sameh Awad
- Interventional Radiology Clinique Labrouste; Paris France
| | - Thibaud Damy
- Cardiology Department; Henri Mondor University Hospital, APHP, Université Paris-Est Créteil; France
| | - Barnabas Gellen
- Cardiology Department; Henri Mondor University Hospital, APHP, Université Paris-Est Créteil; France
- ELSAN, Polyclinique de Poitiers; France
| | - Laurent Sabbah
- Cardiology department; Necker Enfants malades university Hospital, APHP, Université Paris 5; France
| | - Karima Debbache
- Centre de Référence des Syndromes Drépanocytaires Majeurs, Henri Mondor University Hospital, APHP, Université Paris-Est Créteil; France
| | - Vincent Audard
- Nephrology and Renal Transplantation Department Henri Mondor University Hospital; APHP, Université Paris-Est Créteil; France
| | - Jean-Louis Beaumont
- Etablissement français du sang, Henri Mondor University Hospital, APHP, Université Paris-Est Créteil; France
| | - Cécile Arnaud
- Pediatrics Department; Centre hospitalier intercommunal de Créteil; Créteil France
| | - Christelle Chantalat-Auger
- Department of Internal medicine; Bicetre University Hospital; Université Paris 11, le Kremlin-Bicêtre France
| | - Françoise Driss
- Department of Internal medicine; Bicetre University Hospital; Université Paris 11, le Kremlin-Bicêtre France
| | - François Lefrère
- Biotherapy department; Necker-Enfants-Malades-University Hospital, APHP, Université Paris 5; Paris France
| | - Marina Cavazzana
- Biotherapy department; Necker-Enfants-Malades-University Hospital, APHP, Université Paris 5; Paris France
- Centre de Référence des Syndromes Drépanocytaires Majeurs, Necker-Enfants-Malades-University Hospital, APHP, Université Paris 5; Paris France
| | | | - Frederic Galacteros
- Centre de Référence des Syndromes Drépanocytaires Majeurs, Henri Mondor University Hospital, APHP, Université Paris-Est Créteil; France
| | - Jean-Antoine Ribeil
- Biotherapy department; Necker-Enfants-Malades-University Hospital, APHP, Université Paris 5; Paris France
- Centre de Référence des Syndromes Drépanocytaires Majeurs, Necker-Enfants-Malades-University Hospital, APHP, Université Paris 5; Paris France
| | - Justine Gellen-Dautremer
- Centre de Référence des Syndromes Drépanocytaires Majeurs, Henri Mondor University Hospital, APHP, Université Paris-Est Créteil; France
- Internal Medicine Department; Poitiers University Hospital; Poitiers France
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41
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Deux JF, Audard V, Brugières P, Habibi A, Manea EM, Guillaud-Danis C, Godeau B, Galactéros F, Stehlé T, Lang P, Grimbert P, Audureau E, Rahmouni A, Bartolucci P. Magnetic Resonance Imaging Assessment of Kidney Oxygenation and Perfusion During Sickle Cell Vaso-occlusive Crises. Am J Kidney Dis 2017; 69:51-59. [DOI: 10.1053/j.ajkd.2016.07.027] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Accepted: 07/18/2016] [Indexed: 12/25/2022]
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42
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Roy NBA, Fortin PM, Bull KR, Doree C, Trivella M, Hopewell S, Estcourt LJ. Interventions for chronic kidney disease in people with sickle cell disease. Cochrane Database Syst Rev 2016; 2016:CD012380. [PMID: 28344511 PMCID: PMC5360229 DOI: 10.1002/14651858.cd012380] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
This is the protocol for a review and there is no abstract. The objectives are as follows: To assess the effectiveness of any intervention in preventing or reducing kidney complications or CKD in people with SCD (including red blood cell transfusions, hydroxyurea and ACEI (either alone or in combination with each other)).
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Affiliation(s)
- Noemi BA Roy
- University of OxfordWeatherall Institute of Molecular MedicineJohn Radcliffe HospitalHeadley WayOxfordUKOX3 9DU
| | - Patricia M Fortin
- NHS Blood and TransplantSystematic Review InitiativeJohn Radcliffe HospitalOxfordUKOX3 9BQ
| | - Katherine R Bull
- Oxford University Hospitals Trust and the University of OxfordOxford Kidney Unit and Nuffield Department of MedicineCornall Group, Henry Wellcome Building for Molecular PhysiologyRoosevelt DriveOxfordUKOX3 7BN
| | - Carolyn Doree
- NHS Blood and TransplantSystematic Review InitiativeJohn Radcliffe HospitalOxfordUKOX3 9BQ
| | - Marialena Trivella
- University of OxfordCentre for Statistics in MedicineBotnar Research CentreWindmill RoadOxfordUKOX3 7LD
| | - Sally Hopewell
- University of OxfordOxford Clinical Trials Research UnitNuffield Department of Orthopaedics, Rheumatology and Musculoskeletal SciencesWindmill RoadOxfordUKOX3 7LD
| | - Lise J Estcourt
- NHS Blood and TransplantHaematology/Transfusion MedicineLevel 2, John Radcliffe HospitalHeadingtonOxfordUKOX3 9BQ
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43
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Arterial Stiffness Impairment in Sickle Cell Disease Associated With Chronic Vascular Complications. Circulation 2016; 134:923-33. [DOI: 10.1161/circulationaha.115.021015] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Accepted: 07/27/2016] [Indexed: 11/16/2022]
Abstract
Background:
Although a blood genetic disease, sickle cell disease (SCD) leads to a chronic vasculopathy with multiple organ involvement. We assessed arterial stiffness in SCD patients and looked for associations between arterial stiffness and SCD-related vascular complications.
Methods:
The CADRE (Coeur Artères et Drepanocytose, ie, Heart Arteries and Sickle Cell Disease) study prospectively recruited pediatric and adult SCD patients and healthy controls in Cameroon, Ivory Coast, Gabon, Mali, and Senegal. Patients underwent clinical examination, routine laboratory tests (complete blood count, serum creatinine level), urine albumin/creatinine ratio measure, and a measure of carotid-femoral pulse wave velocity (cf-PWV) and augmentation index (AI) at a steady state. The clinical and biological correlates of cf-PWV and AI were investigated by using a multivariable multilevel linear regression analysis with individuals nested in families further nested in countries.
Results:
Included were 3627 patients with SCD and 943 controls. Mean cf-PWV was lower in SCD patients (7.5±2.0 m/s) than in controls (9.1±2.4 m/s,
P
<0.0001), and lower in SS-Sβ
0
than in SC-Sβ
+
phenotypes. AI, corrected for heart rate, increased more rapidly with age in SCD patients and was higher in SCD than in control adults. cf-PWV and AI were independently associated with age, sex, height, heart rate, mean blood pressure, hemoglobin level, country, and hemoglobin phenotype. After adjustment for these correlates, cf-PWV and AI were associated with the glomerular filtration rate and osteonecrosis. AI was also associated with stroke, pulmonary hypertension, and priapism, and cf-PWV was associated with microalbuminuria.
Conclusions:
PWV and AI are deeply modified in SCD patients in comparison with healthy controls. These changes are independently associated with a lower blood pressure and a higher heart rate but also with the hemoglobin phenotype. Moreover, PWV and AI are associated with several SCD clinical complications. Their prognostic value will be assessed at follow-up of the patients.
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Anker N, Scherzer R, Peralta C, Powe N, Banjeree T, Shlipak M. Racial Disparities in Creatinine-based Kidney Function Estimates Among HIV-infected Adults. Ethn Dis 2016; 26:213-20. [PMID: 27103772 DOI: 10.18865/ed.26.2.213] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE The aim of our study was to investigate whether current eGFR equations in clinical use might systematically over-estimate the kidney function, and thus misclassify CKD status, of Black Americans with HIV. Specifically, we evaluated the impact of removing the race coefficient from the MDRD and CKD-EPI equations on comparisons between Black and White HIV-infected veterans related to: 1) the prevalence of reduced eGFR; 2) the distribution of eGFR values; and 3) the relationship between eGFR and all-cause mortality. DESIGN Retrospective cohort study. SETTING The Department of Veterans Affairs (VA) HIV Clinical Case Registry (CCR), which actively monitors all HIV-infected persons receiving care in the VA nationally. PATIENT/PARTICIPANTS 21,905 treatment-naïve HIV-infected veterans. MAIN OUTCOME MEASURES Estimated glomerular filtration rate (eGFR) using the abbreviated Modification of Diet in Renal Disease (MDRD) formula with and without (MDRD-RCR) the race coefficient and all-cause mortality. RESULTS Persons with eGFR <45 mL/min/1.73m(2) had a higher risk of death compared with those with eGFR >80 mL/min/1.73m(2) among both Blacks (HR=2.8, 95%CI: 2.4-3.3) and Whites (HR=1.9, 95%CI: 1.4-2.6), but the association appeared to be stronger in Blacks (P=.038, test for interaction). Blacks with eGFR 45-60 mL/min/1.73m(2) also had a higher risk of death (HR=1.7, 95%CI: 1.4-2.1) but Whites did not (HR=.86, 95%CI: .67-1.10; test for interaction: P<.0001). Racial differences were substantially attenuated when eGFR was re-calculated without the race coefficient. CONCLUSIONS Our findings suggest that clinicians may want to consider estimating glomerular filtration rate without the race coefficient in Blacks with HIV.
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Affiliation(s)
- Naomi Anker
- Department of Medicine, University of California, San Francisco; San Francisco, Veterans Affairs Medical Center
| | | | - Carmen Peralta
- Department of Medicine, University of California, San Francisco
| | - Neil Powe
- Department of Medicine, University of California, San Francisco
| | | | - Michael Shlipak
- Department of Medicine, University of California, San Francisco; San Francisco, Veterans Affairs Medical Center
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Asnani M, Serjeant G, Royal-Thomas T, Reid M. Predictors of renal function progression in adults with homozygous sickle cell disease. Br J Haematol 2016; 173:461-8. [PMID: 27018388 DOI: 10.1111/bjh.13967] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2015] [Accepted: 12/15/2015] [Indexed: 12/16/2022]
Abstract
Longitudinal studies of renal function may improve understanding of the pathophysiological mechanisms underlying sickle cell disease (SCD) nephropathy and may identify possible biological and clinical markers of renal function determined over time. Data from the Jamaica Sickle Cell Cohort Study (JSCCS) were extracted and the glomerular filtration rate (GFR) was estimated using the Chronic Kidney Disease Epidemiological and the SCD specific JSCCS-GFR equations from all adulthood serum creatinine measurements in homozygous SS patients. The other dataset consisted of measured GFR at two times about 13 years apart. Linear mixed model (LMM) regression analyses were conducted to determine predictors of GFR and serum creatinine over time. 191 individuals with SS disease had 867 GFR estimates available. Serum creatinine significantly increased from baseline whereas estimated GFR showed a significant decline. Serum creatinine showed positive association with increasing age, male gender, body mass index and sodium levels. Haemoglobin was a significant negative predictor of estimated GFR in age- and gender-adjusted models. A total of 24 females and 17 males had repeat measurements of their GFR. The mean annual decline in GFR was -3·2 ± 2·83 ml/min/1·73 m(2) . Haemoglobin was a significant positive predictor whereas serum creatinine, systolic blood pressure and urinary albumin: creatinine ratio were negative predictors of GFR.
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Affiliation(s)
- Monika Asnani
- Sickle Cell Unit, Tropical Medicine Research Institute, The University of the West Indies, Kingston 7, Jamaica (W.I.)
| | | | - Tamika Royal-Thomas
- Tropical Metabolism Research Unit, Tropical Medicine Research Institute, The University of the West Indies, Kingston 7, Jamaica (W.I.)
| | - Marvin Reid
- Tropical Metabolism Research Unit, Tropical Medicine Research Institute, The University of the West Indies, Kingston 7, Jamaica (W.I.)
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Wonkam A, Makani J, Ofori-Aquah S, Nnodu OE, Treadwell M, Royal C, Ohene-Frempong K. Sickle cell disease and H3Africa: enhancing genomic research on cardiovascular diseases in African patients. Cardiovasc J Afr 2016; 26:S50-5. [PMID: 25962948 PMCID: PMC4547555 DOI: 10.5830/cvja-2015-040] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Background Sickle cell disease (SCD) has a high prevalence in sub-Saharan Africa. There are several cardiovascular phenotypes in SCD that contribute to its morbidity and mortality. Discussion SCD is characterised by marked clinical variability, with genetic factors playing key modulating roles. Studies in Tanzania and Cameroon have reported that singlenucleotide polymorphisms in BCL11A and HBS1L-MYB loci and co-inheritance of alpha-thalassaemia impact on foetal haemoglobin levels and clinical severity. The prevalence of overt stroke among SCD patients in Cameroon (6.7%) and Nigeria (8.7%) suggests a higher burden than in high-income countries. There is also some evidence of high burden of kidney disease and pulmonary hypertension in SCD; however, the burden and genetics of these cardiovascular conditions have seldom been investigated in Africa. Conclusions Several H3Africa projects are focused on cardiovascular diseases and present major opportunities to build genome-based research on existing SCD platforms in Africa to transform the health outcomes of patients.
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Affiliation(s)
- Ambroise Wonkam
- Division of Human Genetics, Faculty of Health Sciences, University of Cape Town, South Africa.
| | - Julie Makani
- Muhimbili University of Health and Allied Sciences, Dar-Es-Salaam, Tanzania
| | - Solomon Ofori-Aquah
- Center for Translational and International Hematology, University of Pittsburgh, Pittsburgh, USA
| | - Obiageli E Nnodu
- Department of Haematology and Blood Transfusion, College of Health Sciences, University of Abuja, Abuja, Nigeria/Department of Haematology and Blood Transfusion, University of Abuja Teaching Hospital, Gwagwalada, Abuja, Nigeria
| | - Marsha Treadwell
- Hematology/Oncology Department, UCSF Benioff Children's Hospital, Oakland, USA
| | - Charmaine Royal
- Department of African and African American Studies, Duke University, Durham, USA
| | - Kwaku Ohene-Frempong
- Children's Hospital of Philadelphia, Comprehensive Sickle Cell Centre, Philadelphia, USA
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Drawz P, Ayyappan S, Nouraie M, Saraf S, Gordeuk V, Hostetter T, Gladwin MT, Little J. Kidney Disease among Patients with Sickle Cell Disease, Hemoglobin SS and SC. Clin J Am Soc Nephrol 2015; 11:207-15. [PMID: 26672090 DOI: 10.2215/cjn.03940415] [Citation(s) in RCA: 67] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2015] [Accepted: 10/30/2015] [Indexed: 01/21/2023]
Abstract
BACKGROUND AND OBJECTIVES Sickle cell disease (SCD) is an inherited anemia that afflicts millions worldwide. Kidney disease is a major contributor to its morbidity and mortality. We examined contemporary and historical SCD populations to understand how renal disease behaved in hemoglobin SS (HbSS) compared with HbSC. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS Kidney function was examined in the multicentered Treatment of Pulmonary Hypertension and Sickle Cell Disease with Sildenafil Therapy (Walk-PHaSST) Trial (HbSS=463; HbSC=127; years 2007-2009) and historical comparator populations from the Cooperative Study of Sickle Cell Disease (CSSCD; HbSS=708) and the Multicenter Study of Hydroxyurea in Sickle Cell Disease (MSH; HbSS=299). RESULTS In adults with SCD, eGFR was lower among older individuals: -1.78 ml/min per 1.73 m(2) per year of age (95% confidence interval [95% CI], -2.06 to -1.50; Walk-PHaSST Trial), -1.75 ml/min per 1.73 m(2) per year of age (95% CI, -2.05 to -1.44; MSH), and -1.69 ml/min per 1.73 m(2) per year of age (95% CI, -2.00 to -1.38; CSSCD) in HbSS compared with -1.09 ml/min per 1.73 m(2) per year of age (95% CI, -1.39 to -0.75) in HbSC (Walk-PHaSST Trial). Macroalbuminuria was seen in 20% of participants with SCD (HbSS or HbSC; P=0.45; Walk-PHaSST Trial), but microalbuminuria was more prevalent in HbSS (44% versus 23% in HbSC; P<0.002). In the Walk-PHaSST Trial, albuminuria was associated with hemolysis (higher lactate dehydrogenase, P<0.001; higher absolute reticulocyte count, P<0.02; and lower Hb, P=0.07) and elevated systolic BP (P<0.001) in HbSS. One half of all participants with HbSS (20 of 39) versus one fifth without (41 of 228) elevated tricuspid regurgitant jet velocity (≥3 m/s; adverse prognostic indicator in SCD) had macroalbuminuria (P<0.001). In the CSSCD, overt proteinuria, detected (less sensitively) by urine dipstick, associated with higher 3-year mortality (odds ratio, 2.48; 95% CI, 1.07 to 5.77). Serum bicarbonate was lower in HbSS (23.8 versus 24.8 mEq/dl in HbSC; P<0.05) and associated with reticulocytopenic anemia and decreased renal function. CONCLUSIONS In SCD, albuminuria or proteinuria was highly prevalent, in HbSS more than in HbSC. Proteinuria associated with mortality in HbSS. Older individuals had a lower than expected eGFR, and this was more prominent in HbSS. Current management does not routinely address renal complications in SCD, which could plausibly reduce morbidity and mortality.
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Affiliation(s)
- Paul Drawz
- Division of Renal Diseases and Hypertension, University of Minnesota, Minneapolis, Minnesota
| | | | - Mehdi Nouraie
- Center for Sickle Cell Disease, Howard University, Washington, DC
| | - Santosh Saraf
- Division of Hematology/Oncology, University of Illinois, Chicago, Illinois; and
| | | | - Thomas Hostetter
- Nephrology and Hypertension,University Hospitals Case Medical Center, Case Western Reserve University, Cleveland, Ohio
| | - Mark T Gladwin
- Vascular Medicine Institute and Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
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Ackoundou-N'Guessan C, Guei CM, Lagou DA, Gbekedi S, Tia MW, Coulibaly PA, Nzoue S, Konan S, Koffi G, Gnionsahe DA. [Chronic renal failure in sickle cell disease: A retrospective analysis of 100 adults sickle cell patients from black Africa]. Nephrol Ther 2015; 12:149-55. [PMID: 26653399 DOI: 10.1016/j.nephro.2015.08.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2015] [Revised: 08/19/2015] [Accepted: 08/20/2015] [Indexed: 12/13/2022]
Abstract
The prevalence of chronic renal failure (CRF) in sickle cell disease (SCD) patients could vary from one country to another depending on the modalities of management. The aim of the present study was to appreciate the epidemiology of CRF in SCD patients from black Africa in order to search for promoting factors. One hundred SCD adult patients have been considered for the study. The glomerular filtration rate (GFR) has been estimated according to the CKD-EPI formula. Three groups of patients have been identified according to the value of their GFR. The mean age of the patients was 30.84±8.26 years. Male gender has represented 51% of the study population. The mean GFR value was 175.4±86.2 mL/min/1.73 m(2). The prevalence of CRF was 11%. About 3% of them had severe CRF. Subjects with normal GFR were 20%. Subjects with glomerular hyperfiltration (HF) were 69%. By univariate analysis, when subjects with HF were compared with those presenting normal GFR, the following factors have appeared to be significantly associated: female gender (female 60.9% versus male 39.1%; P<0.01), weight <60 kg (weight <60 kg; 53.67±9.45 kg versus weight >60 kg; 59.9±9.41 kg; P<0.008), age <30 years (younger age 29.36±7.9 years versus older age 35.14±8.02 years; P<0.001), lower hemoglobin value (9.38±2,3 g/dL versus 10.33±2.61 g/dL; P<0.04). By logistic regression analysis, age <30 years (age >30 years; OR=0.12 [CI95% 0.03-04]; P<0.001), female gender (male gender; OR=0.17 [0.04-0.64]; P<0.01), weight <60 kg (weight >60 kg; OR=0.19 [CI95% 0.05-0.72]; P<0.01) were associated with HF. By univariate analysis, when subjects with CRF were compared with those presenting normal GFR, a lower hemoglobin value was significantly associated with CRF (7.92±2.7 g/dL versus 10.43±2.5 g/dL; P<0.009). There was a trend for subjects not being under maintenance therapy to more experience CRF (36.4% versus 70%; P<0.07). By logistic regression analysis, only a low hemoglobin value was associated to CRF (higher hemoglobin level; OR=0.55 [0.20-6.3]; P<0.01). In total, CRF and HF are frequent complications in SCD adult patients from black Africa.
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Affiliation(s)
- Clément Ackoundou-N'Guessan
- Service de néphrologie, hémodialyse et transplantation rénale, CHU de Yopougon, université Félix Houphouët-Boigny, Cocody, BP V 32, Abidjan, Côte d'Ivoire.
| | - Cyr Monley Guei
- Service de néphrologie, hémodialyse et transplantation rénale, CHU de Yopougon, université Félix Houphouët-Boigny, Cocody, BP V 32, Abidjan, Côte d'Ivoire
| | - Delphine Amélie Lagou
- Service de néphrologie, hémodialyse et transplantation rénale, CHU de Yopougon, université Félix Houphouët-Boigny, Cocody, BP V 32, Abidjan, Côte d'Ivoire
| | - Serges Gbekedi
- Service de néphrologie, hémodialyse et transplantation rénale, CHU de Yopougon, université Félix Houphouët-Boigny, Cocody, BP V 32, Abidjan, Côte d'Ivoire
| | - Mélanie Weu Tia
- Service de néphrologie, hémodialyse et transplantation rénale, CHU de Yopougon, université Félix Houphouët-Boigny, Cocody, BP V 32, Abidjan, Côte d'Ivoire
| | - Pessa Albert Coulibaly
- Service de néphrologie, hémodialyse et transplantation rénale, CHU de Yopougon, université Félix Houphouët-Boigny, Cocody, BP V 32, Abidjan, Côte d'Ivoire
| | - Sita Nzoue
- Service de néphrologie, hémodialyse et transplantation rénale, CHU de Yopougon, université Félix Houphouët-Boigny, Cocody, BP V 32, Abidjan, Côte d'Ivoire
| | - Serges Konan
- Service de néphrologie, hémodialyse et transplantation rénale, CHU de Yopougon, université Félix Houphouët-Boigny, Cocody, BP V 32, Abidjan, Côte d'Ivoire
| | - Gustave Koffi
- Service d'hématologie clinique, CHU de Yopougon, université Félix Houphouët-Boigny, Cocody, BP V 32, Abidjan, Côte d'Ivoire
| | - Daze Apollinaire Gnionsahe
- Service de néphrologie, hémodialyse et transplantation rénale, CHU de Yopougon, université Félix Houphouët-Boigny, Cocody, BP V 32, Abidjan, Côte d'Ivoire
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Bartolucci P, Habibi A, Stehlé T, Di Liberto G, Rakotoson MG, Gellen-Dautremer J, Loric S, Moutereau S, Sahali D, Wagner-Ballon O, Remy P, Lang P, Grimbert P, Audureau E, Godeau B, Galacteros F, Audard V. Six Months of Hydroxyurea Reduces Albuminuria in Patients with Sickle Cell Disease. J Am Soc Nephrol 2015; 27:1847-53. [PMID: 26586692 DOI: 10.1681/asn.2014111126] [Citation(s) in RCA: 67] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2014] [Accepted: 09/07/2015] [Indexed: 12/22/2022] Open
Abstract
The earliest symptom of glomerular injury in patients with sickle cell disease (SCD) is microalbuminuria. The effect of hydroxyurea (HU) on urine albumin-to-creatinine ratio (ACR) is unclear and should be determined, because increasing numbers of patients with SCD take this drug to improve red blood cell function. In this cohort study of 58 SS-homozygous adults with SCD who initiated HU therapy, we evaluated ACR changes and relationships of these changes with demographic, clinical, and biologic parameters at HU initiation (baseline) and 6 months later (follow-up). Between baseline and follow-up, ACR declined significantly for the entire population (3.0-1.7 mg/mmol; P<0.01), but this was primarily driven by the ACR reduction in the microalbuminuria subgroup (8.1-2.3 mg/mmol; P=0.03; n=23). According to bivariate analyses on 39 patients who did not receive a blood transfusion during the study period, the baseline to follow-up ACR decline was strongly associated with decreases in levels of hemolysis markers, percentage of dense red blood cells, and systolic BP. Bivariate analysis also revealed a close association between the ACR decrease and high baseline levels of hemolysis markers and percentage of dense red blood cells. These results show that urine ACR decreased significantly after 6 months of HU and confirm a close relationship between ACR and hemolysis evolution in patients with SCD.
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Affiliation(s)
- Pablo Bartolucci
- Sickle Cell Referral Center, Department of Internal Medicine, Unité Institut National de la Santé Et de la Recherche Médicale (INSERM) U955, Equipe 2 and Laboratory of Excellence Globule Rouge Excellence (GR-Ex), Paris, France Groupe Hospitalier Henri Mondor-Albert Chenevier, Assistance Publique-Hôpitaux de Paris, Université Paris-Est Créteil, Creteil, France;
| | - Anoosha Habibi
- Sickle Cell Referral Center, Department of Internal Medicine, Groupe Hospitalier Henri Mondor-Albert Chenevier, Assistance Publique-Hôpitaux de Paris, Université Paris-Est Créteil, Creteil, France
| | - Thomas Stehlé
- Groupe Hospitalier Henri Mondor-Albert Chenevier, Assistance Publique-Hôpitaux de Paris, Université Paris-Est Créteil, Creteil, France; Department of Nephrology and Renal Transplantation
| | - Gaetana Di Liberto
- Unité Institut National de la Santé Et de la Recherche Médicale (INSERM) U955, Equipe 2 and Laboratory of Excellence Globule Rouge Excellence (GR-Ex), Paris, France Groupe Hospitalier Henri Mondor-Albert Chenevier, Assistance Publique-Hôpitaux de Paris, Université Paris-Est Créteil, Creteil, France
| | - Marie Georgine Rakotoson
- Unité Institut National de la Santé Et de la Recherche Médicale (INSERM) U955, Equipe 2 and Laboratory of Excellence Globule Rouge Excellence (GR-Ex), Paris, France Groupe Hospitalier Henri Mondor-Albert Chenevier, Assistance Publique-Hôpitaux de Paris, Université Paris-Est Créteil, Creteil, France
| | - Justine Gellen-Dautremer
- Sickle Cell Referral Center, Department of Internal Medicine, Groupe Hospitalier Henri Mondor-Albert Chenevier, Assistance Publique-Hôpitaux de Paris, Université Paris-Est Créteil, Creteil, France
| | - Sylvain Loric
- Groupe Hospitalier Henri Mondor-Albert Chenevier, Assistance Publique-Hôpitaux de Paris, Université Paris-Est Créteil, Creteil, France; Departement de Biochimie-Pharmacotoxicologie
| | - Stéphane Moutereau
- Groupe Hospitalier Henri Mondor-Albert Chenevier, Assistance Publique-Hôpitaux de Paris, Université Paris-Est Créteil, Creteil, France; Departement de Biochimie-Pharmacotoxicologie
| | - Dil Sahali
- Groupe Hospitalier Henri Mondor-Albert Chenevier, Assistance Publique-Hôpitaux de Paris, Université Paris-Est Créteil, Creteil, France; Department of Nephrology and Renal Transplantation, Unité INSERM U955, Equipe 21, Idiopathic Nephrotic Syndrome Referral Center, Université Paris-Est Créteil, Creteil, France; and
| | - Orianne Wagner-Ballon
- Groupe Hospitalier Henri Mondor-Albert Chenevier, Assistance Publique-Hôpitaux de Paris, Université Paris-Est Créteil, Creteil, France; Department of Hematology and Immunology Biology, and
| | - Philippe Remy
- Groupe Hospitalier Henri Mondor-Albert Chenevier, Assistance Publique-Hôpitaux de Paris, Université Paris-Est Créteil, Creteil, France; Department of Nephrology and Renal Transplantation, Unité INSERM U955, Equipe 21, Idiopathic Nephrotic Syndrome Referral Center, Université Paris-Est Créteil, Creteil, France; and
| | - Philippe Lang
- Groupe Hospitalier Henri Mondor-Albert Chenevier, Assistance Publique-Hôpitaux de Paris, Université Paris-Est Créteil, Creteil, France; Department of Nephrology and Renal Transplantation, Unité INSERM U955, Equipe 21, Idiopathic Nephrotic Syndrome Referral Center, Université Paris-Est Créteil, Creteil, France; and
| | - Philippe Grimbert
- Groupe Hospitalier Henri Mondor-Albert Chenevier, Assistance Publique-Hôpitaux de Paris, Université Paris-Est Créteil, Creteil, France; Department of Nephrology and Renal Transplantation, Unité INSERM U955, Equipe 21, Idiopathic Nephrotic Syndrome Referral Center, Université Paris-Est Créteil, Creteil, France; and
| | - Etienne Audureau
- Groupe Hospitalier Henri Mondor-Albert Chenevier, Assistance Publique-Hôpitaux de Paris, Université Paris-Est Créteil, Creteil, France; Public Health Unit EA (Equipe d'Accueil) 7376 CEpiA (Clinical Epidemiology And Ageing Unit, and
| | - Bertrand Godeau
- Department of Internal Medicine, Groupe Hospitalier Henri Mondor-Albert Chenevier, Assistance Publique-Hôpitaux de Paris, Université Paris-Est Créteil, Creteil, France
| | - Frédéric Galacteros
- Sickle Cell Referral Center, Department of Internal Medicine, Unité Institut National de la Santé Et de la Recherche Médicale (INSERM) U955, Equipe 2 and Laboratory of Excellence Globule Rouge Excellence (GR-Ex), Paris, France Groupe Hospitalier Henri Mondor-Albert Chenevier, Assistance Publique-Hôpitaux de Paris, Université Paris-Est Créteil, Creteil, France
| | - Vincent Audard
- Groupe Hospitalier Henri Mondor-Albert Chenevier, Assistance Publique-Hôpitaux de Paris, Université Paris-Est Créteil, Creteil, France; Department of Nephrology and Renal Transplantation, Unité INSERM U955, Equipe 21, Idiopathic Nephrotic Syndrome Referral Center, Université Paris-Est Créteil, Creteil, France; and
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50
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Kord Valeshabad A, Wanek J, Saraf SL, Gaynes BI, Gordeuk VR, Molokie RE, Shahidi M. Changes in Conjunctival Hemodynamics Predict Albuminuria in Sickle Cell Nephropathy. Am J Nephrol 2015; 41:487-93. [PMID: 26278102 DOI: 10.1159/000438678] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Accepted: 07/07/2015] [Indexed: 01/02/2023]
Abstract
BACKGROUND Albuminuria is an early manifestation of deterioration in renal function in subjects with sickle cell disease (SCD). Hyperfiltration may be an early mechanism for kidney damage in SCD. The purpose of the current study was to determine the association between conjunctival hemodynamics and albuminuria in SCD subjects with preserved glomerular filtration rate. METHODS Conjunctival microcirculation imaging was performed to measure conjunctival diameter and axial blood velocity (V) in 35 SCD and 10 healthy control subjects. Albuminuria, defined as albumin excretion ratio (AER), was obtained from the medical charts. Based on the 95% CI of conjunctival V in control subjects (0.40-0.60 mm/s), SCD subjects were allocated to 3 groups: V1 <0.40 mm/s (n = 7), V2 of 0.40-0.60 mm/s (n = 18) and V3 ≥0.60 mm/s (n = 10). RESULTS Mean log(AER) measurements in the V1, V2 and V3 groups were 1.08 ± 0.67, 1.39 ± 0.59 and 2.00 ± 0.91 mg/g creatinine, respectively, and followed a positive linear trend from the V1 to V3 groups (p = 0.01). By multivariate linear regression analysis, conjunctival V significantly correlated with albuminuria (p = 0.01) independent of age, blood pressure, α-thalassemia, hematocrit, white blood cell count and lactate dehydrogenase concentration. CONCLUSIONS Increased conjunctival V is associated with albuminuria in SCD subjects. Assessment of conjunctival microvascular hemodynamics may improve our understanding of the pathophysiology and clinical management of sickle cell nephropathy.
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Affiliation(s)
- Ali Kord Valeshabad
- Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, Ill., USA
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