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Evaluating risk factors for chronic kidney disease in pediatric patients with sickle cell anemia
Jeffrey D Lebensburger1, Gary R Cutter2, Thomas H Howard3
1Pediatric Hematology and Oncology, University of Alabama at Birmingham, 1600 7th Ave South, Lowder 512, Birmingham, AL, 35233, USA. jlebensburger@peds.uab.edu.
Insights
In children and adolescents with sickle cell anemia (SCA), hyperuricemia and nocturnal hypertension are linked to reduced kidney function (eGFR). Further research is needed to understand their role in chronic kidney disease (CKD) progression.
Area of Science:
- Nephrology
- Pediatrics
- Hematology
Background:
- Sickle cell anemia (SCA) patients face higher risks of kidney disease (nephropathy) and related mortality.
- Chronic kidney disease (CKD) is a significant concern in individuals with SCA.
Purpose of the Study:
- To investigate the association between hyperuricemia, nocturnal hypertension, and estimated glomerular filtration rate (eGFR) in pediatric and adolescent SCA patients.
- To identify potential early markers for kidney dysfunction in SCA.
Main Methods:
- Assessed eGFR using cystatin-C in SCA patients (ages 10-21) with HbSS or HbSB0 genotypes.
- Measured uric acid levels and conducted 24-hour ambulatory blood pressure monitoring (ABPM).
- Defined hyperuricemia (uric acid ≥5.5 mg/dL) and nocturnal hypertension based on established pediatric norms.
Main Results:
- Patients with hyperuricemia had significantly lower mean eGFR compared to those with normal uric acid levels.
- Nocturnal hypertension (systolic and diastolic) was also associated with significantly lower mean eGFR.
- Regression analysis confirmed that both nocturnal hypertension and hyperuricemia independently correlated with reduced eGFR.
Conclusions:
- Nocturnal hypertension and hyperuricemia are identified as risk factors associated with lower eGFR in pediatric and adolescent SCA patients.
- These findings suggest a potential role for these factors in the development and progression of SCA nephropathy.
- Long-term studies are recommended to confirm the impact of these factors on CKD progression in SCA.
Background:
Patients with sickle cell anemia (SCA) have an increased prevalence of nephropathy and mortality from chronic kidney disease (CKD).
Methods:
We evaluated the association of hyperuricemia and nocturnal hypertension with lower estimated glomerular filtration rate (eGFR) using cystatin-C in patients aged 10-21 years with the HbSS or HbSB0 form of the disease during a non-acute clinic visit. eGFR and uric acid measurements were obtained in 83 and 81 participants, respectively, and 24-h ambulatory blood pressure monitoring (ABPM) was performed in 44 participants. Annual testing included vital signs, complete blood count, comprehensive metabolic panel, medications, urine microalbumin/creatinine, and lactate dehydrogenase measurements. Hyperuricemia was defined as a uric acid level of ≥5.5 mg/dL. Nocturnal hypertension was defined as >25% of nocturnal readings at >95th percentile according to norms established by the American Heart Association Statement on ABPM in children and adolescents.
Results:
The mean eGFR was statistically significantly lower in patients with hyperuricemia than in those with normal uric acid levels (143 vs. 161 mL/min/1.73 m2, respectively). Of the 44 participants for whom ABPM data were available, 14 (32%) had systolic nocturnal hypertension and 12 (27%) had diastolic nocturnal hypertension. The mean eGFR was statistically significantly lower in participants with nocturnal systolic and diastolic hypertension than in those with normal nocturnal blood pressure. In a regression model, nocturnal hypertension and hyperuricemia were associated with a lower eGFR.
Conclusions:
Two risk factors for CKD, i.e., nocturnal hypertension and hyperuricemia, were associated with lower eGFR in older children and adolescent patients with SCA. Long-term studies on their association with progression to CKD in this population are warranted.
Key Point:
Nocturnal hypertension and hyperuricemia are established risk factors for nephropathy in other diseases and may play a role in SCA nephropathy.