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Occult Kidney Dysfunction in Children With Transfusion-Dependent Thalassemia
Nurwahida Mohd Zikre1, Nor A Muhamad2, Caroline S Y Eng3
1Paediatric Unit, Faculty of Medicine, University Malaya, Kuala Lumpur, Malaysia.
Frontiers in Pediatrics
|December 9, 2021
Summary
Kidney dysfunction affects 37% of children with transfusion-dependent thalassemia (TDT), with risks increasing with earlier diagnosis and longer transfusion duration. Early screening is crucial for timely intervention in pediatric thalassemia patients.
Area of Science:
- Pediatrics
- Nephrology
- Hematology
Background:
- Thalassemia is a prevalent hemoglobinopathy in Southeast Asia.
- Kidney dysfunction is an underrecognized complication in children with thalassemia.
- This study focuses on transfusion-dependent thalassemia (TDT).
Purpose of the Study:
- To determine the prevalence of kidney dysfunction in children with TDT.
- To identify predisposing factors for kidney dysfunction in this pediatric cohort.
- To highlight the need for active screening and surveillance.
Main Methods:
- Retrospective study of 81 children with TDT.
- Abnormal kidney function defined by GFR <90 ml/min/1.73 m² or significant GFR decline or nephrotic proteinuria.
- Analysis of age at diagnosis, transfusion duration, iron chelation, ferritin, and hemoglobin levels.
Main Results:
- 37% of children (30/81) exhibited abnormal kidney function.
- Glomerular hyperfiltration was observed in 25.85% at the last visit, rising to 59.3% over a 3-year period.
- Increased risk of kidney dysfunction was associated with younger age at diagnosis (RR 1.157) and longer transfusion duration (RR 0.984).
Conclusions:
- Kidney dysfunction in pediatric TDT patients can be easily missed without active screening.
- Systematic surveillance is essential for early detection of kidney issues in children receiving regular transfusions.
- Timely interventions are critical for managing kidney dysfunction in this population.
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