Early renal damage in patients with sickle cell disease in sub-Saharan Africa: a multinational, prospective, cross-sectional study
Summary Background Chronic kidney disease is one of the leading causes of mortality in patients with sickle cell disease. However, it has been almost exclusively studied in patients with the SS phenotype and in high-income countries, despite more than 80% of patients living in Africa. We looked for...
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| creator | Ranque, Brigitte, Dr Menet, Aymeric, MD Diop, Ibrahima Bara, Prof Thiam, Marie Michèle, MD Diallo, Dapa, Prof Diop, Saliou, Prof Diagne, Ibrahima, Prof Sanogo, Ibrahima, Prof Kingue, Samuel, Prof Chelo, David, MD Wamba, Guillaume, MD Diarra, Mamadou, Prof Anzouan, Jean Baptiste, Prof N'Guetta, Roland, Prof Diakite, Cheick Oumar, MD Traore, Youssouf, MD Legueun, Gaëlle, MD Deme-Ly, Indou, MD Belinga, Suzanne, MD Boidy, Kouakou, MD Kamara, Ismael, MD Tharaux, Pierre-Louis, MD Jouven, Xavier, Prof |
| description | Summary Background Chronic kidney disease is one of the leading causes of mortality in patients with sickle cell disease. However, it has been almost exclusively studied in patients with the SS phenotype and in high-income countries, despite more than 80% of patients living in Africa. We looked for the determinants of glomerulopathy in a multinational cohort of patients with sickle cell disease of different phenotypes in sub-Saharan Africa. Methods In the CADRE cohort, we prospectively included patients 3 years and older with sickle cell disease of all haemoglobin phenotypes in Cameroon, Côte d'Ivoire, Mali, and Senegal. All individuals were assessed at steady state. The main outcome of interest was albuminuria defined as a urine albumin-to-creatinine ratio of greater than 30 mg/g. We investigated the clinical and biological determinants (including haemolysis markers) of albuminuria in two main phenotype groups (SS and Sβ0 ; SC and Sβ+ ) with further stratification by age and country. Findings The study is ongoing because of follow-up. 2582 patients with sickle cell disease were included (1776 SS, 136 Sβ0 , 511 SC, and 159 Sβ+ ). 644 patients with the SS and Sβ0 phenotypes (33·7%, 95% CI 31·6–35·8) and 110 with the SC and Sβ+ phenotypes (16·4%, 13·6–19·2) had albuminuria. In the SS and Sβ0 group, albuminuria was detected in 144 (27%) of 527 children younger than 10 years and its frequency increased with age (29 [48%] of 60 patients aged >40 years). Multivariable analysis showed that albuminuria was associated with age (odds ratio 1·43, 95% CI 1·20–1·71; p |
| doi_str_mv | 10.1016/S2352-3026(14)00007-6 |
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However, it has been almost exclusively studied in patients with the SS phenotype and in high-income countries, despite more than 80% of patients living in Africa. We looked for the determinants of glomerulopathy in a multinational cohort of patients with sickle cell disease of different phenotypes in sub-Saharan Africa. Methods In the CADRE cohort, we prospectively included patients 3 years and older with sickle cell disease of all haemoglobin phenotypes in Cameroon, Côte d'Ivoire, Mali, and Senegal. All individuals were assessed at steady state. The main outcome of interest was albuminuria defined as a urine albumin-to-creatinine ratio of greater than 30 mg/g. We investigated the clinical and biological determinants (including haemolysis markers) of albuminuria in two main phenotype groups (SS and Sβ0 ; SC and Sβ+ ) with further stratification by age and country. Findings The study is ongoing because of follow-up. 2582 patients with sickle cell disease were included (1776 SS, 136 Sβ0 , 511 SC, and 159 Sβ+ ). 644 patients with the SS and Sβ0 phenotypes (33·7%, 95% CI 31·6–35·8) and 110 with the SC and Sβ+ phenotypes (16·4%, 13·6–19·2) had albuminuria. In the SS and Sβ0 group, albuminuria was detected in 144 (27%) of 527 children younger than 10 years and its frequency increased with age (29 [48%] of 60 patients aged >40 years). Multivariable analysis showed that albuminuria was associated with age (odds ratio 1·43, 95% CI 1·20–1·71; p<0·0001), female sex (1·35, 1·02–1·82; p=0·045), low haemoglobin (0·79, 0·66–0·93; p=0·006), high lactate dehydrogenase concentrations (1·33, 1·14–1·58; p=0·0009), and, using Côte d'Ivoire as the reference, Mali (2·49, 1·64–3·79; p=0·042) and Cameroon (1·59, 1·01–2·51; p=0·0007) in patients with the SS and Sβ0 phenotypes. The magnitude of the association of albuminuria with haemoglobin and lactate dehydrogenase concentrations increased with age. In the SC and Sβ+ patients, only low haemoglobin (0·69, 0·48–0·97; p=0·029), high blood pressure (1·63, 1·17–2·27; p=0·0017), and Mali (3·75, 1·75–8·04; p<0·0001) were associated with albuminuria. Interpretation Hyperhaemolysis is associated with albuminuria, with an age-dependent effect, in the SS and Sβ0 phenotypes only, suggesting a different pathological mechanism for glomerular disease in the patients with SC and Sβ+ phenotypes. However, both phenotypes are associated with a high prevalence of albuminuria in childhood. Therefore, screening for albuminuria is advised in African children with sickle cell disease to detect early renal damage. Funding Paris Cité Sorbonne University (GrEX project) and Cardiology and Development.</description><identifier>ISSN: 2352-3026</identifier><identifier>EISSN: 2352-3026</identifier><identifier>DOI: 10.1016/S2352-3026(14)00007-6</identifier><identifier>PMID: 27030156</identifier><language>eng</language><publisher>England: Elsevier Inc</publisher><subject>Hematology, Oncology and Palliative Medicine</subject><ispartof>The Lancet. Haematology, 2014-11, Vol.1 (2), p.e64-e73</ispartof><rights>Elsevier Ltd</rights><rights>2014 Elsevier Ltd</rights><rights>Copyright © 2014 Elsevier Ltd. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c420t-6898d9bd529c0f07db25397c83cacaae14fb9cdf45c722f340fed4c976c80aa73</citedby><cites>FETCH-LOGICAL-c420t-6898d9bd529c0f07db25397c83cacaae14fb9cdf45c722f340fed4c976c80aa73</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,27901,27902</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/27030156$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Ranque, Brigitte, Dr</creatorcontrib><creatorcontrib>Menet, Aymeric, MD</creatorcontrib><creatorcontrib>Diop, Ibrahima Bara, Prof</creatorcontrib><creatorcontrib>Thiam, Marie Michèle, MD</creatorcontrib><creatorcontrib>Diallo, Dapa, Prof</creatorcontrib><creatorcontrib>Diop, Saliou, Prof</creatorcontrib><creatorcontrib>Diagne, Ibrahima, Prof</creatorcontrib><creatorcontrib>Sanogo, Ibrahima, Prof</creatorcontrib><creatorcontrib>Kingue, Samuel, Prof</creatorcontrib><creatorcontrib>Chelo, David, MD</creatorcontrib><creatorcontrib>Wamba, Guillaume, MD</creatorcontrib><creatorcontrib>Diarra, Mamadou, Prof</creatorcontrib><creatorcontrib>Anzouan, Jean Baptiste, Prof</creatorcontrib><creatorcontrib>N'Guetta, Roland, Prof</creatorcontrib><creatorcontrib>Diakite, Cheick Oumar, MD</creatorcontrib><creatorcontrib>Traore, Youssouf, MD</creatorcontrib><creatorcontrib>Legueun, Gaëlle, MD</creatorcontrib><creatorcontrib>Deme-Ly, Indou, MD</creatorcontrib><creatorcontrib>Belinga, Suzanne, MD</creatorcontrib><creatorcontrib>Boidy, Kouakou, MD</creatorcontrib><creatorcontrib>Kamara, Ismael, MD</creatorcontrib><creatorcontrib>Tharaux, Pierre-Louis, MD</creatorcontrib><creatorcontrib>Jouven, Xavier, Prof</creatorcontrib><title>Early renal damage in patients with sickle cell disease in sub-Saharan Africa: a multinational, prospective, cross-sectional study</title><title>The Lancet. Haematology</title><addtitle>Lancet Haematol</addtitle><description>Summary Background Chronic kidney disease is one of the leading causes of mortality in patients with sickle cell disease. However, it has been almost exclusively studied in patients with the SS phenotype and in high-income countries, despite more than 80% of patients living in Africa. We looked for the determinants of glomerulopathy in a multinational cohort of patients with sickle cell disease of different phenotypes in sub-Saharan Africa. Methods In the CADRE cohort, we prospectively included patients 3 years and older with sickle cell disease of all haemoglobin phenotypes in Cameroon, Côte d'Ivoire, Mali, and Senegal. All individuals were assessed at steady state. The main outcome of interest was albuminuria defined as a urine albumin-to-creatinine ratio of greater than 30 mg/g. We investigated the clinical and biological determinants (including haemolysis markers) of albuminuria in two main phenotype groups (SS and Sβ0 ; SC and Sβ+ ) with further stratification by age and country. Findings The study is ongoing because of follow-up. 2582 patients with sickle cell disease were included (1776 SS, 136 Sβ0 , 511 SC, and 159 Sβ+ ). 644 patients with the SS and Sβ0 phenotypes (33·7%, 95% CI 31·6–35·8) and 110 with the SC and Sβ+ phenotypes (16·4%, 13·6–19·2) had albuminuria. In the SS and Sβ0 group, albuminuria was detected in 144 (27%) of 527 children younger than 10 years and its frequency increased with age (29 [48%] of 60 patients aged >40 years). Multivariable analysis showed that albuminuria was associated with age (odds ratio 1·43, 95% CI 1·20–1·71; p<0·0001), female sex (1·35, 1·02–1·82; p=0·045), low haemoglobin (0·79, 0·66–0·93; p=0·006), high lactate dehydrogenase concentrations (1·33, 1·14–1·58; p=0·0009), and, using Côte d'Ivoire as the reference, Mali (2·49, 1·64–3·79; p=0·042) and Cameroon (1·59, 1·01–2·51; p=0·0007) in patients with the SS and Sβ0 phenotypes. The magnitude of the association of albuminuria with haemoglobin and lactate dehydrogenase concentrations increased with age. In the SC and Sβ+ patients, only low haemoglobin (0·69, 0·48–0·97; p=0·029), high blood pressure (1·63, 1·17–2·27; p=0·0017), and Mali (3·75, 1·75–8·04; p<0·0001) were associated with albuminuria. Interpretation Hyperhaemolysis is associated with albuminuria, with an age-dependent effect, in the SS and Sβ0 phenotypes only, suggesting a different pathological mechanism for glomerular disease in the patients with SC and Sβ+ phenotypes. However, both phenotypes are associated with a high prevalence of albuminuria in childhood. Therefore, screening for albuminuria is advised in African children with sickle cell disease to detect early renal damage. Funding Paris Cité Sorbonne University (GrEX project) and Cardiology and Development.</description><subject>Hematology, Oncology and Palliative Medicine</subject><issn>2352-3026</issn><issn>2352-3026</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2014</creationdate><recordtype>article</recordtype><recordid>eNqFkctO3TAQhq2qqCDKI7Tykkqk9S120kURQvQiIbGArq2JPSmGXE7thOps--R1ciiqusEbe-xv_vH8Q8gbzt5zxvWHayFLUUgm9DFX71heptAvyMHT9ct_zvvkKKW7zHBpdKnrV2RfGCYZL_UB-X0BsdvSiAN01EMPP5CGgW5gCjhMif4K0y1Nwd13SB12mQkJIa1QmpviGm4hwkDP2hgcfKRA-7mbwpDzxyx5QjdxTBt0U3jAE-pykIq0hMsrTdPst6_JXgtdwqPH_ZB8_3xxc_61uLz68u387LJwSrCp0FVd-brxpagda5nxjShlbVwlHTgA5KptaudbVTojRCsVa9ErVxvtKgZg5CE53unmL_2cMU22D2npCQYc52S5MaauZFWqjJY7dP1wxNZuYughbi1ndpmAXSdgF3stV3adgNU57-1jibnp0T9l_fU7A6c7AHOjDwGjTS4b7dCHmF2xfgzPlvj0n4LrwpC97-5xi-lunGN2Nndjk7BsJ7JocLUqaPkHchSr9Q</recordid><startdate>20141101</startdate><enddate>20141101</enddate><creator>Ranque, Brigitte, Dr</creator><creator>Menet, Aymeric, MD</creator><creator>Diop, Ibrahima Bara, Prof</creator><creator>Thiam, Marie Michèle, MD</creator><creator>Diallo, Dapa, Prof</creator><creator>Diop, Saliou, Prof</creator><creator>Diagne, Ibrahima, Prof</creator><creator>Sanogo, Ibrahima, Prof</creator><creator>Kingue, Samuel, Prof</creator><creator>Chelo, David, MD</creator><creator>Wamba, Guillaume, MD</creator><creator>Diarra, Mamadou, Prof</creator><creator>Anzouan, Jean Baptiste, Prof</creator><creator>N'Guetta, Roland, Prof</creator><creator>Diakite, Cheick Oumar, MD</creator><creator>Traore, Youssouf, MD</creator><creator>Legueun, Gaëlle, MD</creator><creator>Deme-Ly, Indou, MD</creator><creator>Belinga, Suzanne, MD</creator><creator>Boidy, Kouakou, MD</creator><creator>Kamara, Ismael, MD</creator><creator>Tharaux, Pierre-Louis, MD</creator><creator>Jouven, Xavier, Prof</creator><general>Elsevier Inc</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20141101</creationdate><title>Early renal damage in patients with sickle cell disease in sub-Saharan Africa: a multinational, prospective, cross-sectional study</title><author>Ranque, Brigitte, Dr ; Menet, Aymeric, MD ; Diop, Ibrahima Bara, Prof ; Thiam, Marie Michèle, MD ; Diallo, Dapa, Prof ; Diop, Saliou, Prof ; Diagne, Ibrahima, Prof ; Sanogo, Ibrahima, Prof ; Kingue, Samuel, Prof ; Chelo, David, MD ; Wamba, Guillaume, MD ; Diarra, Mamadou, Prof ; Anzouan, Jean Baptiste, Prof ; N'Guetta, Roland, Prof ; Diakite, Cheick Oumar, MD ; Traore, Youssouf, MD ; Legueun, Gaëlle, MD ; Deme-Ly, Indou, MD ; Belinga, Suzanne, MD ; Boidy, Kouakou, MD ; Kamara, Ismael, MD ; Tharaux, Pierre-Louis, MD ; Jouven, Xavier, Prof</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c420t-6898d9bd529c0f07db25397c83cacaae14fb9cdf45c722f340fed4c976c80aa73</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2014</creationdate><topic>Hematology, Oncology and Palliative Medicine</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Ranque, Brigitte, Dr</creatorcontrib><creatorcontrib>Menet, Aymeric, MD</creatorcontrib><creatorcontrib>Diop, Ibrahima Bara, Prof</creatorcontrib><creatorcontrib>Thiam, Marie Michèle, MD</creatorcontrib><creatorcontrib>Diallo, Dapa, Prof</creatorcontrib><creatorcontrib>Diop, Saliou, Prof</creatorcontrib><creatorcontrib>Diagne, Ibrahima, Prof</creatorcontrib><creatorcontrib>Sanogo, Ibrahima, Prof</creatorcontrib><creatorcontrib>Kingue, Samuel, Prof</creatorcontrib><creatorcontrib>Chelo, David, MD</creatorcontrib><creatorcontrib>Wamba, Guillaume, MD</creatorcontrib><creatorcontrib>Diarra, Mamadou, Prof</creatorcontrib><creatorcontrib>Anzouan, Jean Baptiste, Prof</creatorcontrib><creatorcontrib>N'Guetta, Roland, Prof</creatorcontrib><creatorcontrib>Diakite, Cheick Oumar, MD</creatorcontrib><creatorcontrib>Traore, Youssouf, MD</creatorcontrib><creatorcontrib>Legueun, Gaëlle, MD</creatorcontrib><creatorcontrib>Deme-Ly, Indou, MD</creatorcontrib><creatorcontrib>Belinga, Suzanne, MD</creatorcontrib><creatorcontrib>Boidy, Kouakou, MD</creatorcontrib><creatorcontrib>Kamara, Ismael, MD</creatorcontrib><creatorcontrib>Tharaux, Pierre-Louis, MD</creatorcontrib><creatorcontrib>Jouven, Xavier, Prof</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>The Lancet. Haematology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Ranque, Brigitte, Dr</au><au>Menet, Aymeric, MD</au><au>Diop, Ibrahima Bara, Prof</au><au>Thiam, Marie Michèle, MD</au><au>Diallo, Dapa, Prof</au><au>Diop, Saliou, Prof</au><au>Diagne, Ibrahima, Prof</au><au>Sanogo, Ibrahima, Prof</au><au>Kingue, Samuel, Prof</au><au>Chelo, David, MD</au><au>Wamba, Guillaume, MD</au><au>Diarra, Mamadou, Prof</au><au>Anzouan, Jean Baptiste, Prof</au><au>N'Guetta, Roland, Prof</au><au>Diakite, Cheick Oumar, MD</au><au>Traore, Youssouf, MD</au><au>Legueun, Gaëlle, MD</au><au>Deme-Ly, Indou, MD</au><au>Belinga, Suzanne, MD</au><au>Boidy, Kouakou, MD</au><au>Kamara, Ismael, MD</au><au>Tharaux, Pierre-Louis, MD</au><au>Jouven, Xavier, Prof</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Early renal damage in patients with sickle cell disease in sub-Saharan Africa: a multinational, prospective, cross-sectional study</atitle><jtitle>The Lancet. Haematology</jtitle><addtitle>Lancet Haematol</addtitle><date>2014-11-01</date><risdate>2014</risdate><volume>1</volume><issue>2</issue><spage>e64</spage><epage>e73</epage><pages>e64-e73</pages><issn>2352-3026</issn><eissn>2352-3026</eissn><abstract>Summary Background Chronic kidney disease is one of the leading causes of mortality in patients with sickle cell disease. However, it has been almost exclusively studied in patients with the SS phenotype and in high-income countries, despite more than 80% of patients living in Africa. We looked for the determinants of glomerulopathy in a multinational cohort of patients with sickle cell disease of different phenotypes in sub-Saharan Africa. Methods In the CADRE cohort, we prospectively included patients 3 years and older with sickle cell disease of all haemoglobin phenotypes in Cameroon, Côte d'Ivoire, Mali, and Senegal. All individuals were assessed at steady state. The main outcome of interest was albuminuria defined as a urine albumin-to-creatinine ratio of greater than 30 mg/g. We investigated the clinical and biological determinants (including haemolysis markers) of albuminuria in two main phenotype groups (SS and Sβ0 ; SC and Sβ+ ) with further stratification by age and country. Findings The study is ongoing because of follow-up. 2582 patients with sickle cell disease were included (1776 SS, 136 Sβ0 , 511 SC, and 159 Sβ+ ). 644 patients with the SS and Sβ0 phenotypes (33·7%, 95% CI 31·6–35·8) and 110 with the SC and Sβ+ phenotypes (16·4%, 13·6–19·2) had albuminuria. In the SS and Sβ0 group, albuminuria was detected in 144 (27%) of 527 children younger than 10 years and its frequency increased with age (29 [48%] of 60 patients aged >40 years). Multivariable analysis showed that albuminuria was associated with age (odds ratio 1·43, 95% CI 1·20–1·71; p<0·0001), female sex (1·35, 1·02–1·82; p=0·045), low haemoglobin (0·79, 0·66–0·93; p=0·006), high lactate dehydrogenase concentrations (1·33, 1·14–1·58; p=0·0009), and, using Côte d'Ivoire as the reference, Mali (2·49, 1·64–3·79; p=0·042) and Cameroon (1·59, 1·01–2·51; p=0·0007) in patients with the SS and Sβ0 phenotypes. The magnitude of the association of albuminuria with haemoglobin and lactate dehydrogenase concentrations increased with age. In the SC and Sβ+ patients, only low haemoglobin (0·69, 0·48–0·97; p=0·029), high blood pressure (1·63, 1·17–2·27; p=0·0017), and Mali (3·75, 1·75–8·04; p<0·0001) were associated with albuminuria. Interpretation Hyperhaemolysis is associated with albuminuria, with an age-dependent effect, in the SS and Sβ0 phenotypes only, suggesting a different pathological mechanism for glomerular disease in the patients with SC and Sβ+ phenotypes. However, both phenotypes are associated with a high prevalence of albuminuria in childhood. Therefore, screening for albuminuria is advised in African children with sickle cell disease to detect early renal damage. Funding Paris Cité Sorbonne University (GrEX project) and Cardiology and Development.</abstract><cop>England</cop><pub>Elsevier Inc</pub><pmid>27030156</pmid><doi>10.1016/S2352-3026(14)00007-6</doi></addata></record> |
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| title | Early renal damage in patients with sickle cell disease in sub-Saharan Africa: a multinational, prospective, cross-sectional study |
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