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Clinical features and risk factors of renal dysfunctions in thalassemic patients

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Abstract

Introduction

Chronic anemia, iron overload, and iron chelation therapy are the main contributing factors for renal complications in thalassemia, e.g., nephrolithiasis, glomerular disease, and renal tubular dysfunction. The prevalence and associated factors for developing renal dysfunctions in Thai patients with thalassemia, however, remained limited. This study aimed to determine the prevalence and risk factors of renal dysfunctions in patients with thalassemia.

Methods

A cross-sectional study was conducted on adult patients with thalassemia disease at Srinagarind Hospital, Khon Kaen University, Thailand. All patients were evaluated for complete blood count, blood chemistry, urinalysis, and urine biochemistry. Renal tubular dysfunction was defined as existing in at least one of the following parameters including; proteinuria, hypercalciuria, hypouricemia with uricosuria, or hypophosphatemia with phosphaturia. Logistic regression analysis was used to identify associated factors for renal dysfunctions.

Results

Of 105 patients, renal tubular dysfunction was found in 60 patients (57.1%). In multivariate analysis of the clinical risk factors for renal tubular dysfunction in thalassemia patients, age per 10 year increase (adjusted odds ratio [AOR] = 1.4, 95% CI: 1.0–2.0, p value 0.01) and Hb E/beta-thalassemia (AOR = 3.6, 95% CI: 1.3–10.3, p value 0.01) were statistically proven to be associated with renal tubular dysfunction. Hyperuricosuria was a significantly associated factor for microhematuria. (AOR = 2.9, 95% CI: 1.1–8.0, p value 0.03).

Conclusions

Renal dysfunctions are prevalent in thalassemia patients, with older age and Hb E/beta-thalassemia genotype as significant risk factors for renal tubular dysfunction. Hyperuricosuria is a risk factor for microhematuria. Renal dysfunctions should be recognized and monitored in aging patients with Hb E/beta-thalassemia.

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Data availability

The data that support the findings of this study are available on request from the corresponding author [N.T.]. The data are not publicly available due to “them containing information that could compromise research participant privacy/consent”.

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Acknowledgements

The authors would like to thank Emeritus Professor James A. Will, University of Wisconsin-Madison, for helping in preparing the manuscript via publication clinic of Khon Kaen University, Thailand.

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Authors and Affiliations

  1. Division of Hematology, Department of Internal Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand

    Phaosin Thongsaen, Chinadol Wanitpongpun, Theerin Lanamtieng, Pisa Phiphitaporn & Nattiya Teawtrakul

  2. Division of Nephrology, Department of Internal Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand

    Pantipa Tonsawan

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Contributions

PT: collected clinical data and wrote the first draft of the manuscript; PT: generally supervised the study; CW, TL, PP: collected clinical data, NT: designed the study, performed statistical analysis, and made the final revision of the manuscript. All authors approved the final version of the manuscript and the submission to International Urology and Nephrology journal.

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Correspondence to Nattiya Teawtrakul.

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The authors report no conflicts of interest.

Ethical approval

All participants gave informed consent to participate and publish the data. The study was performed under the Declaration of Helsinki. The research protocol was approved by the Ethics committee for Human Research of Khon Kaen University (reference number HE641045).

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Thongsaen, P., Tonsawan, P., Wanitpongpun, C. et al. Clinical features and risk factors of renal dysfunctions in thalassemic patients. Int Urol Nephrol 55, 1779–1785 (2023). https://doi.org/10.1007/s11255-023-03506-3

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