Glomerular filtration rate in children with sickle cell disease in the Eastern Region of Saudi Arabia

Abstract

Introduction Sickle cell nephropathy (SCN) is a serious complication of SCD that starts insidiously in childhood, with possible progression to chronic kidney disease in adulthood. Our aim was to study the prevalence and clinical correlates of the glomerular filtration rate, the earliest marker of renal dysfunction, in the Eastern Region of Saudi Arabia (SA). Methods A retrospective cross-sectional study was performed on 114 Saudi children with SCD aged 1-14 years who attended the pediatric hematology clinic in a steady state. Renal function was evaluated via estimated glomerular filtration rate (eGFR). The prevalence of GHF, and the correlation of eGFR with different clinical and laboratory data were investigated. Moreover, a comparison of the clinical characteristics and eGFRs was performed between children from the Southwestern (SW) and Eastern regions of Saudi Arabia (SA) and living in the same Eastern environment. Results A total of 114 children with SCD were included in the study (Male to female ratio: 1.3:1). The mean age was 8.8 ± 3.2 years. They were divided into two groups based on their provenance: Eastern (n: 26/114) and SW (n: 88/114). The mean eGFR was 179.4±52.7 ml/min/1.73 m2 with a glomerular hyperfiltration (GHF) prevalence of (44.7%). There was no statistical difference between the two groups in terms of the mean GFR or prevalence of GHF (p>0.5). The eGFR correlated with hemolytic markers, including steady-state hemoglobin (HB) (r = −0.25, P 0.003), hematocrit (r=-0.27, p 0.002), HBF (r=-0.28, p 0.001), reticulocytes% (r=0.225, p 0.016), AST(r = 0.32, p 0.000), LDH (r=0.30, p 0.001)and bilirubin (r=0.317, p O.001). In the multivariate regression of the factors determining the eGFR at 95% confidence intervals, only HBF (β =0.216, P = 0.042) remained independently predictive (R2 = 0.197, p= 0.001). There was no correlation between the GFR and patient age, BP, WBC or platelet count. Conclusion: The prevalence of GHF among Saudi children with SCD in the Eastern region is high, with no significant difference between Eastern and SW patients. The eGFR was correlated with the hemolytic markers, and low HBF was predictive of GHF. Further studies are needed to validate these findings.