Impact of Hydroxyurea therapy on albuminuria among children with sickle cell anemia Open Access

Tehseen, Sarah (2016)

Permanent URL: https://etd.library.emory.edu/concern/etds/fx719n204?locale=en
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Abstract

Background: The process of renal damage in sickle cell anemia (SCA) is progressive and leads to end stage renal disease in 12% of adult sickle cell patients. Hydroxyurea (HU) is known to successfully reduce many complications of sickle cell disease. However, its role in sickle cell nephropathy remains uncertain.

Objectives: To investigate the effect of HU on progression of sickle cell nephropathy as estimated by urine albumin to creatinine ratios (ACR) in children with HbSS/Sβ0 phenotype. AIM 1: Compare the urine ACR levels post- vs. pre-initiation of HU among patients with SCA. AIM 2: Among SCA patients with albuminuria, compare the urine ACR levels between SCA patients on HU and age-matched SCA patients not on HU.

Methods: This retrospective cohort study was conducted in tertiary care children's hospital between 2010 and 2013, with up to 2 years of follow-up. The main outcome was urine ACR. Other covariates included age, mean hemoglobin levels, indices of HU compliance and blood pressure. A paired t test or appropriate non-parametric test was used to compare urine ACR levels post- vs. pre-initiation of HU. An independent sample t test was used to compare change in urine ACR levels between exposed and unexposed patients. Multiple linear regression models were used to investigate the impact of HU therapy on change in ACR while adjusting for other covariates (AIM 2).

Results: AIM 1: The final number of patients included was 81. Urine ACR levels were significantly lower ~2 years after initiation of HU compared to levels pre-HU (7±15 two years post HU vs. 11.4±24 pre-HU; p=0.02 N=65). This change was most pronounced among patients who had abnormal ACR levels before initiation of HU (N=21; 23.4±39 2 years post-HU vs. 95±103 pre-HU; p=0.02). AIM 2: The final number of patients included was 48. HU therapy was associated with a significant reduction in ACR over ~1 year of follow up compared to patients not on HU, controlling for age and baseline hemoglobin.

Conclusion: HU therapy in SCA is associated with lower urine ACR levels over time.

Table of Contents

INTRODUCTION……………………………………………………………………..1

BACKGROUND…………………………………………………………………….....3

METHODS………………………………………………………………………….... 8

RESULTS…………………………………………………………………………….. 18

DISCUSSION…………………………………………………………………………24

REFERENCES………………………………………………………………………..30

FIGURES AND TABLES..…………………………………………………………..33

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