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Effect of renin-angiotensin-aldosterone system blocking agents on progression of glomerulopathy in sickle cell

Ashley Thrower1, Emily J Ciccone2, Poulami Maitra3

  • 1School of Medicine, University of North Carolina, Chapel Hill, NC, USA.

British Journal of Haematology
|November 22, 2018
PubMed

Insights

Renin-angiotensin-aldosterone system (RAAS) blocking agents did not significantly differ in reducing proteinuria long-term for sickle cell disease (SCD) patients. However, RAAS blockade may slow the decline in kidney function (eGFR) in these patients.

Area of Science:

  • Nephrology
  • Hematology
  • Pharmacology

Background:

  • Renin-angiotensin-aldosterone system (RAAS) inhibitors are known to reduce albuminuria short-term.
  • Long-term efficacy of RAAS blockers in sickle cell disease (SCD) remains unconfirmed.
  • Kidney disease is a significant complication in SCD.

Purpose of the Study:

  • To evaluate the long-term effects of RAAS blocking agents on proteinuria and estimated glomerular filtration rate (eGFR) decline in patients with SCD.
  • To compare the outcomes of SCD patients on RAAS blockers versus those not on treatment.

Main Methods:

  • Retrospective, single-center study.
  • Compared 86 SCD patients on RAAS blockers for proteinuria with 68 SCD patients not on RAAS blockers.
  • Median follow-up of approximately 2.3 years.

Main Results:

  • Proteinuria decreased over time in both groups, with no statistically significant difference between them.
  • Estimated glomerular filtration rate (eGFR) declined in both groups, but the decline was significantly slower in patients on RAAS blocking agents.
  • RAAS blocking agents did not significantly affect mortality, though baseline eGFR was associated with mortality.

Conclusions:

  • RAAS blockade may slow the rate of kidney function loss in patients with SCD.
  • Further research is needed to confirm the long-term benefits of RAAS inhibitors in SCD nephropathy.

Keywords:
albuminuriaangiotensin converting enzyme inhibitorsestimated glomerular filtration raterenin-angiotensin-aldosterone blocking agentssickle cell disease

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