Abstract: TH-PO445

Cardiovascular Outcomes in CKD Patients with Sickle Cell Disorders

Session Information

Category: Chronic Kidney Disease (Non-Dialysis)

  • 303 CKD: Epidemiology, Outcomes - Cardiovascular

Authors

  • Olaniran, Kabir O., Massachusetts General Hospital, Boston, Massachusetts, United States
  • Eneanya, Nwamaka Denise, Massachusetts General Hospital, Boston, Massachusetts, United States
  • Allegretti, Andrew S., Massachusetts General Hospital, Boston, Massachusetts, United States
  • Xu, Dihua, Massachusetts General Hospital, Boston, Massachusetts, United States
  • Thadhani, Ravi I., Massachusetts General Hospital, Boston, Massachusetts, United States
Background

Sickle cell disease (SCD) patients are known to be at risk for ischemic stroke (CVA), heart failure (HF) and chronic kidney disease (CKD). However, cardiovascular (CV) outcomes in SCD CKD patients have not been described. Additionally, sickle cell trait (SCT) is independently associated with CKD. However, the effect of SCT with concurrent CKD on CV outcomes has not been explored.

Methods

We performed a multi-hospital retrospective cohort study in Boston using adult KDIGO criteria CKD patients between 2005-2017. Chart review was used to ascertain the following exposures: SCT with CKD, SCD with CKD and the reference group (RG; black race with CKD with normal hemoglobin electrophoresis). Outcomes were identified using diagnosis codes and defined as incident coronary heart disease (CHD), HF and CVA. Exposures and outcomes confirmed by diagnosis code only were then added for sensitivity analysis.

Results

960 CKD subjects were initially included (241 SCT CKD, 45 SCD CKD, 674 RG). The mean baseline GFR in SCD CKD patients was higher vs the RG despite similar proportions per CKD stage (80±50 vs 70±36ml/min, p=0.17). SCD CKD patients were significantly younger (41±14 vs 52±17yrs, p<0.01), had lower mean systolic blood pressure (129±21 vs 137±23mmHg, p=0.03), fewer co-morbidities and less CV risk treatment vs the RG. No other significant differences in the baseline characteristics of the SCT CKD vs the RG were noted. Initial analysis showed an increasingly positive trend towards CHD risk from the RG to SCT CKD to SCD CKD which did not persist with HF and CVA. After adjustment for age, co-morbidities and medications, we found significantly increased odds for CHD in SCT CKD (OR 1.6, 95% CI 1.1-2.4) and SCD CKD (OR 3.2, 95% CI 1.2-8.3) compared to the RG. SCD CKD patients also had significantly increased odds for CVA (OR 3.8, 95% CI 1.2-12.3) and HF (OR 2.5, 95% CI 1.2-5.2) after multivariable analysis. Sensitivity analysis of 9,078 CKD subjects (360 SCT CKD, 498 SCD CKD, 8,220 RG) revealed similar findings.

Conclusion

Patients with CKD and either concurrent SCT or SCD have increased odds for adverse CV outcomes. Larger studies are needed to confirm these findings and to determine best practices for CV disease prevention in this patient population.