Progressive Decline in Estimated GFR in Patients With Sickle Cell Disease: An Observational Cohort Study
Abstract
Rationale and Objective: Progression of chronic kidney disease (CKD) in sickle cell disease (SCD) and its risk factors remain poorly defined. We identified characteristics associated with CKD as well as decline of estimated glomerular filtration rate (eGFR) and presence of proteinuria over time in adults with SCD. Study Design: Retrospective, observational study. Setting & Participants: SCD patients ≥ 18 years old in a single center from 2004–2013. Predictors: Baseline clinical and laboratory measures, comorbidities, SCD-related complications and severity of genotypes defined as severe (HbSS/HbSβ0 thalassemia) or mild (HbSC/HbSβ+ thalassemia). Outcomes: Presence at baseline of CKD, defined as eGFR < 90 mL/min/1.73 m2 or proteinuria as ≥1+ greater on urinalysis or current kidney transplant or dialysis; change in eGFR; and incident proteinuria. Analytical Approach: Logistic regression for baseline CKD. Linear mixed effects model for eGFR decline and generalized linear mixed effects model for proteinuria during the study period evaluating for interaction with time. Stratified by genotype severity. Results: Among 427 patients, 331 had ≥ 2 measures of creatinine. Over median follow-up of 4.01 (interquartile range, 1.66–7.19) years, the annual eGFR decline was 2.05 mL/min/1.73 m2 for severe genotypes (p<0.001) and 1.16 mL/min/1.73 m2 (p=0.02) for mild genotypes. At baseline, 21.4% of patients with severe genotypes had CKD versus 17.2% of those with mild genotypes. For severe…
How strong is the evidence?
Evidence Hub reads this as a cohort study, done in people. Its evidence level is 3 of 5 (Moderate · trial / cohort / secondary analysis). Trials without a large randomized design, cohorts and secondary analyses give moderate evidence. Reported size: 427 participants or records.
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