Evaluation of renal function of sickle cell children in Libreville by estimation of glomerular creatinine-cystatin C filtration rate: prevalence of acute kidney injury and associated factors

Authors

  • Steeve Mintoo Department of Paediatrics, Université des Sciences de la Santé, Libreville, Gabon https://orcid.org/0000-0002-9529-4915
  • Fifi C. Loembe Department of Paediatrics, Université des Sciences de la Santé, Libreville, Gabon
  • Sylvie Mpira Department of Paediatrics, Université des Sciences de la Santé, Libreville, Gabon
  • Nathalie Nguemou Department of Paediatrics, Université des Sciences de la Santé, Libreville, Gabon
  • Joel Djoba Siawaya National Public Health Laboratory, Libreville, Gabon
  • Jean Koko Department of Paediatrics, Université des Sciences de la Santé, Libreville, Gabon
  • Simon J. Ategbo Department of Paediatrics, Université des Sciences de la Santé, Libreville, Gabon

DOI:

https://doi.org/10.18203/2349-3291.ijcp20241285

Keywords:

SCD, Children, CKD, Gabon

Abstract

Background: Sickle cell disease (SCD) is an important and growing global health problem. Kidney damage is one of the most common complications of SCD. We aimed to determine the prevalence of acute kidney injury (AKI) in children with SCD in our context.

Methods: Cross-sectional and analytical study from January 2022 to September 2022, including SCD children aged from 6 months to 17 years during their hospitalisation. We measured the estimated glomerular filtration (eGFR) rate using the combined creatinine and cystatin C formula for kids (CKiDScr-Cys C). Univariate analyses were performed to measure the relationship between variables and AKI and eGFR, followed by a multivariate analysis using logistic regression.

Results: Of the 137 children, we included 82 boys (60%) and 55 girls (40%). The mean eGFR was 112±45.3 ml/min/1.73 m2. A total of 36 subjects, or 26.3% (95% CI [18.9-33.6%)), had acute AKI. Comparison of characteristics by AKI status showed significant differences according the number of transfusions (p<0.01), and hemoglobin level (p<0.027), eGFR had a negative correlation with the number of transfusions r=-0.308 (-0.477; -0.117); p<0.01. Multivariate analysis showed that nutritional status was a protective factor of AKI (p<0.01), and the number of transfusions was a predictive factor of AKI in SCD in our context (p<0.001).

Conclusions: The results from our study are an urgent alarm to implement the existing management programs on SCD from screening to universal access of hydroxyurea in order to reduce complications and mortality related to this pathology.

References

Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 Sickle Cell Disease Collaborators. Global, regional, and national prevalence and mortality burden of sickle cell disease, 2000-2021: a systematic analysis from the Global Burden of Disease Study 2021. Lancet Haematol. 2023;10(8):E585-99.

Adebayo OC, Van den Heuvel LP, Olowu W, Levtechenko EN, Labarque V. Sickle cell nephropathy: insights into the pediatric population. Pediatr Nephrol. 2022;37(6):1231-43.

Afangbedji N, Jerebtsova M. Glomerular filtration rate abnormalities in sickle cell disease. Front Med. 2022;9:1029224.

Belisário AR, Dda Silva AA, Silva CV, De Souza LM, Wakabayashi EA, et al. Sickle cell disease nephropathy: an update on risk factors and potential biomarkers in pediatric patients. Biomark Med. 2019;13(11):967-87.

Kidney Disease Improving Global Outcomes (KDIGO). KDIGO 2023 clinical practice guideline for the evaluation and management of chronic kidney disease. Available at: KDIGO-2023-CKD-Guideline-Public-Review-Draft5-July-2023.pdf. Accessed on 28 January, 2024.

Ndour EHM, Dione R, Gueye Tall F, Mazandu GK, Mnika K, et al. Determination of glomerular filtration rate during sickle cell disease in Senegal: Schwartz, Cockcroft and Gault, MDRD, CKD-EPI or JSCCS? Int J Biol Chem Sci. 2021;15(6):2283-96.

Delicate-Loembet LM, Elguero E, Arnathau C, Durand P, Ollomo B, Ossari S, et al. Prevalence of the sickle cell trait in Gabon: a nationwide study. Infect Genet Evol. 2014;25:52-6.

Piel FB, Steinberg MH, Rees DC. Sickle Cell Disease. N Engl J Med. 2017;377(3):305.

Zoleko Manego R, Koehne E, Kreidenweiss A, Nzigou Mombo B, Adegbite BR, Dimessa Mbadinga LB, et al. Description of Plasmodium falciparum infections in central Gabon demonstrating high parasite densities among symptomatic adolescents and adults. Malar J. 2019;18(1):371.

Roy NB, Carpenter A, Dale-Harris I, Dorée C, Estcourt LJ. Interventions for chronic kidney disease in people with sickle cell disease. Cochrane Database Syst Rev. 2023;8(8):CD012380.

Amarapurkar P, Roberts L, Navarrete J, El Rassi F. Sickle Cell Disease and Kidney. Adv Chronic Kidney Dis 2022;29(2):141-8.

Directorate-General for Statistics (DGS). Third Demographic and Health Survey (2019-2021) 2023 (French). Gabon-Third Demographic and Health Survey 2019-2021. Available at: https://dhsprogram.com/publications/publication-FR371-DHS-Final-Reports.cfm. Accessed on 28 January, 2024.

World Health Organization, African Region. African health ministers launch drive to curb sickle cell disease toll 2022. Available at: https://www.afro.who.int/news/african-health-ministers-launch-drive-curb-sickle-cell-disease-toll. Accessed on 28 January, 2024.

WHO. Blood safety and availability. 2020. Available at: https://www.who.int/news-room/fact-sheets/detail/blood-safety-and-availability. Accessed on 28 January, 2024.

Maitland K, Kiguli S, Olupot-Olupot P, Opoka RO, Chimalizeni Y, Alaroker F, et al. Transfusion management of severe anaemia in African children: a consensus algorithm. Br J Haematol. 2021;193(6):1247-59.

Payán-Pernía S, Ruiz Llobet A, Remacha Sevilla ÁF, Egido J, Ballarín Castán JA, Moreno JA. Sickle cell nephropathy. Clinical manifestations and new mechanisms involved in kidney injury. Nefrologia (Engl Ed). 2021;41(4):373-82.

Piel FB, Rees DC, DeBaun MR, Nnodu O, Ranque B, Thompson AA, et al. Defining global strategies to improve outcomes in sickle cell disease: a Lancet Haematology Commission. Lancet Haematol. 2023;10(8):E633-86.

Doughty HA, Hervig TA. Whole blood for transfusion in sub-Saharan Africa. Lancet Glob Health. 2022;10(3):E303-4.

George EC, Uyoga S, M'baya B, Kyeyune Byabazair D, Kiguli S, Olupot-Olupot P, et al. TRACT trial study group. Whole blood versus red cell concentrates for children with severe anaemia: a secondary analysis of the Transfusion and Treatment of African Children (TRACT) trial. Lancet Glob Health. 2022;10(3):E360-8.

Islam MR, Moinuddin MD, Ahmed A, Rahman SM. Association of sickle cell disease with anthropometric indices 1 among under-five children: evidence from 2018 Nigeria Demographic and Health Survey. BMC Med. 2021;19(1):5.

The World Bank. GDP per capita. 2022. Available at: https://data.worldbank.org/indicator/NY.GDP.PCAP.CD. Accessed on 28 January, 2024.

Alexandre-Heymann L, Dubert M, Diallo DA, Diop S, Tolo A, Belinga S, et al. Prevalence and correlates of growth failure in young African patients with sickle cell disease. Br J Haematol. 2019;184(2):253-62.

Williams TN. Undernutrition: a major but potentially preventable cause of poor outcomes in children living with sickle cell disease in Africa. BMC Med. 2021;19(1):17.

Dutta D, Methe B, Amar S, Morris A, Lim SH. Intestinal injury and gut permeability in sickle cell disease. J Transl Med. 2019;17(1):183.

Olaniran KO, Eneanya ND, Allegretti AS, Zhao SH, Achebe MM, Thadhani RI. Cardiovascular Outcomes in African Americans with Sickle Cell Trait and Chronic Kidney Disease. Am J Nephrol. 2019;49(2):93-102.

Neugarten J, Golestaneh L. Sex Differences in Acute Kidney Injury. Semin Nephrol. 2022;42(2):208-18.

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Published

2024-05-06

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Original Research Articles