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Estimated glomerular filtration rate in Brazilian adults with sickle cell disease: results from the REDS-III multicenter cohort study

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Abstract  

Chronic kidney disease (CKD) has a significant impact on sickle cell disease (SCD) morbidity and mortality. Early identification of individuals at highest risk of developing CKD may allow therapeutic intervention to prevent worse outcomes. This study aimed to evaluate the prevalence and risk factors for reduced estimated glomerular filtration rate (eGFR) among adults with SCD in Brazil. Participants in the REDS-III multicenter SCD cohort with more severe genotypes aged ≥ 18 years with at least two serum creatinine values were analyzed. The eGFR was calculated using the Jamaica Sickle Cell Cohort Study GFR equation. The eGFR categories were defined according to the K/DOQI. Participants with eGFR ≥ 90 were compared to those with those with eGFR < 90. Among the 870 participants, 647 (74.4%) had eGFR ≥ 90, 211 (24.3%) had eGFR 60 to 89, six (0.7%) had eGFR 30 to 59, and six (0.7%) had ESRD. Male sex (OR: 37.3; 95%CI: 22.4–65.1), higher age (OR: 1.04; 95%CI: 1.02–1.06), higher diastolic blood pressure (OR: 1.03; 95%CI: 1.009–1.06), lower Hb (OR: 0.80; 95%CI: 0.68–0.93), and lower reticulocytes (OR: 0.94; 95%CI: 0.89–0.99) levels were independently associated with eGFR < 90. There was a trend towards higher odds of death in participants with eGFR < 90 (OR: 1.8; 95%CI: 0.95–3.32; p = 0.065). In turn, participants with eGFR < 60 had a 12.2 (95%CI: 2.1–96.9) times higher odds for death when compared to those with eGFR ≥ 60. In this study, eGFR < 90 was observed in one-quarter of adults. Older age, male sex, higher diastolic blood pressure, lower hemoglobin, and lower reticulocyte levels were associated with occurrence of eGFR < 90. Estimated GFR < 60 increased the risk of mortality.

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Data Availability

The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.

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Acknowledgements 

First, the authors acknowledge all participants and parents of pediatric participants for their cooperation in being part of this the study. The authors also thank the staff at all participating Brazilian and American research sites. Without all of these contributions, this study would not have been possible. This work was supported by the NHLBI Recipient Epidemiology and Donor Evaluation Study-III: International Component (Brazil), with the participation of the following centers and investigators. Brazilian participants: Instituto de Medicina Tropical de São Paulo (USP)—Ester C. Sabino, Cecilia Alencar; Fundação Pró-Sangue (São Paulo)—Alfredo Mendrone Jr., Cesar de Almeida Neto, Ligia Capuani; Instituto de Tratamento do Câncer Infantil (São Paulo)—Miriam Park; Faculdade de Medicina da Universidade de São Paulo (São Paulo)—Paula Blatyta; Hemominas—Belo Horizonte (Minas Gerais)—Anna Bárbara de Freitas Carneiro-Proietti, Carolina Miranda Teixeira, Tassila Salomon, Franciane Mendes de Oliveira, Valquíria Reis; Hemominas, Montes Claros (Minas Gerais)—Rosemere Afonso Mota, José Wilson Sales; Hemominas—Juiz de Fora (Minas Gerais)—Daniela de Oliveira Werneck; Fundação Hemope – Recife (Pernambuco)—Paula Loureiro, Aderson Araújo, Maria do Carmo Valgueir; Hemorio (Rio de Janeiro)—Clarisse Lobo, Claudia Maximo; Instituto de Matemática e Estatística da Universidade de São Paulo—USP (São Paulo)—João Eduardo Ferreira, Márcio Katsumi Oikawa, Pedro Losco Takecian, Mina Cintho Ozahata, Rodrigo Muller de Carvalho. US investigators: Vitalant Research Institute and University of California San Francisco—Brian Scott Custer, Michael P. Busch, Shannon Kelly and Thelma Therezinha Gonçalez; RTI—Research Triangle Institute—Donald Brambilla, Liliana RPreiss, Christopher McClure; UCSF Benioff Children’s Hospital Oakland—Carolyn Hoppe; National Heart, Lung, and Blood Institute, NIH—Simone A. Glynn.

Funding

The Recipient Epidemiology and Donor Evaluation Study (REDS-III Brazil) was supported by the National Institutes of Health, National Heart, Lung, and Blood Institute under contracts HHSN268201100007I. André Rolim Belisário received a scholarship from the International Traineeships in AIDS Prevention Studies program (ITAPS) to participate in a scientific manuscript writing program at University of California, San Francisco.

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Authors and Affiliations

  1. Centro de Tecidos Biológicos de Minas Gerais, Fundação Hemominas, Rua das Goiabeiras, 779, Lagoa Santa, MG, 33400-000, Brazil

    André Rolim Belisário, Anna Bárbara Carneiro-Proietti, Daniela de Oliveira Werneck Rodrigues & Rosimere Afonso Mota

  2. Laboratório Interdisciplinar de Investigação Médica, Faculdade de Medicina, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Brazil

    André Rolim Belisário & Ana Cristina Simões e Silva

  3. Faculdade Ciências Médicas, Belo Horizonte, MG, Brazil

    Isabel Cristina Gomes Moura

  4. Faculdade de Medicina (FMUSP) and Instituto de Medicina Tropical, Universidade de São Paulo, São Paulo, Brazil

    Ester Cerdeira Sabino

  5. Fundação Hemope, Recife, PE, Brazil

    Paula Loureiro

  6. Universidade de Pernambuco, Recife, PE, Brazil

    Paula Loureiro

  7. Hemorio, Rio de Janeiro, Brazil

    Cláudia Máximo

  8. ITACI, Unidade de Onco-Hematologia, Instituto da Criança, HCFMUSP, São Paulo, Brazil

    Miriam V. Flor-Park

  9. Department of Computer Science - DCC, University of São Paulo, São Paulo, Brazil

    Mina Cintho Ozahata

  10. Pró-Sangue, São Paulo, Brazil

    Carla Luana Dinardo

  11. UCSF Benioff Children’s Hospital, Oakland, CA, USA

    Shannon Kelly

  12. Vitalant Research Institute, San Francisco, CA, USA

    Brian Custer

  13. Department of Laboratory Medicine, UCSF, San Francisco, CA, USA

    Brian Custer

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  1. André Rolim Belisário
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  2. Ana Cristina Simões e Silva
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  3. Isabel Cristina Gomes Moura
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  13. Shannon Kelly
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  14. Brian Custer
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for the Recipient Epidemiology and Donor Evaluation Study (REDS-III) International Component Brazil

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Correspondence to André Rolim Belisário.

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Belisário, A.R., Simões e Silva, A.C., Moura, I.C.G. et al. Estimated glomerular filtration rate in Brazilian adults with sickle cell disease: results from the REDS-III multicenter cohort study. Ann Hematol 102, 1019–1027 (2023). https://doi.org/10.1007/s00277-023-05150-4

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