Kidney Function Decline among Black Patients with Sickle Cell Trait and Sickle Cell Disease: An Observational Cohort Study
| Autor: | Kabir O. Olaniran, Maureen Achebe, Sagar U. Nigwekar, Sophia H. Zhao, Ravi Thadhani, Andrew S. Allegretti, Sahir Kalim, Nwamaka D. Eneanya |
|---|---|
| Rok vydání: | 2019 |
| Předmět: |
Adult
Male Oncology medicine.medical_specialty Hemoglobin Sickle Cell Black People Renal function Anemia Sickle Cell Disease Sickle Cell Trait Cohort Studies Elevated hemoglobin Up Front Matters Internal medicine Diabetes mellitus medicine Humans In patient Renal Insufficiency Chronic Sickle cell trait business.industry General Medicine Middle Aged medicine.disease medicine.anatomical_structure Nephrology Female business Glomerular Filtration Rate Cohort study |
| Zdroj: | J Am Soc Nephrol |
| ISSN: | 1533-3450 1046-6673 |
| Popis: | 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. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|