Longitudinal study of glomerular hyperfiltration and normalization of estimated glomerular filtration in adults with sickle cell disease. (16th August 2021)

• Record Type: Journal Article
• Authors: Derebail, Vimal K.; Zhou, Qingning; Ciccone, Emily J.; Cai, Jianwen; Ataga, Kenneth I.
• Is Part Of: British journal of haematology. Volume 195:Number 1(2021)
• Page Start: 123
• Page End: 132
• Publication Date: 2021-08-16
• Subjects: estimated glomerular filtration rate -- haemoglobin -- hyperfiltration -- proteinuria -- sickle cell disease; Hematology -- Periodicals; Blood -- Diseases -- Periodicals; 616.15
• DOI: 10.1111/bjh.17723
• Languages: English
• ISSNs: 0007-1048

Abstract

Summary: Glomerular hyperfiltration is common in sickle cell disease (SCD) and precedes proteinuria and declining kidney function. We evaluated hyperfiltration in SCD patients and its "normalization." Routine visit data were collected retrospectively from adult SCD patients in a single centre from 2004 to 2013. Baseline was defined as first available serum creatinine and hyperfiltration as estimated glomerular filtration rates (eGFR) >130 ml/min/1·73 m 2 for women and >140 ml/min/1·73 m 2 for men. Normalization of hyperfiltration was eGFR reduction to 90–130 ml/min/1·73 m 2 for women or 90–140 ml/min/1·73 m 2 for men. Among 292 patients, median age was 27 years [interquartile range (IQR):20·0–38·0], and 56·8% had baseline hyperfiltration. Baseline hyperfiltration was inversely associated with age [odds ratio (OR):0·86, 95% confidence interval (CI): 0·82–0·90; P < 0·0001], male sex (OR:0·16, 95% CI: 0·07–0·41; P = 0·0001), haemoglobin (OR:0·76, 95% CI 0·61–0·94; P = 0·01), weight (OR:0·96, 95% CI: 0·93–0·99; P = 0·004), and angiotensin‐converting enzyme inhibitor/angiotensin receptor blocker (ACE‐I/ARB) use (OR:0·08, 95% CI: 0·01–0·75; P = 0·03), and positively with hydroxycarbamide use (OR:2·99, 95% CI: 1·18–7·56; P = 0·02). Of 89 hyperfiltration patients without baseline proteinuria, 10 (11·2%) developed new‐onset proteinuria [median 1·05 years (IQR:0·63–2·09)]. Normalization of hyperfiltration was less likely with higher baseline eGFR [hazard ratio (HR):0·90, 95% CI: 0·86–0·95; P < 0·0001] and more likely in males (HR:6·35, 95% CI:2·71–14·86, <0·0001). Hyperfiltration is common in adult SCD patients, particularly when younger. Decline to normal values is more likely in males, possibly representing kidney function loss rather than improvement in hyperfiltration.