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Abstract: FR-OR08

AKI Among African Americans with Sickle Cell Trait and Disease

Session Information

Category: Acute Kidney Injury

  • 101 AKI: Epidemiology, Risk Factors, and Prevention

Authors

  • Olaniran, Kabir O., Massachusetts General Hospital, Boston, Massachusetts, United States
  • Allegretti, Andrew S., Massachusetts General Hospital, Boston, Massachusetts, United States
  • Zhao, Sophia, Massachusetts General Hospital, Boston, Massachusetts, United States
  • Nigwekar, Sagar U., Massachusetts General Hospital, Boston, Massachusetts, United States
  • Kalim, Sahir, Massachusetts General Hospital, Boston, Massachusetts, United States
Background

Sickle cell trait (SCT) and disease (SCD) are independent risk factors for estimated glomerular filtration rate (eGFR) decline among African Americans (AA). However, our understanding of the risk for acute kidney injury (AKI) and the role of AKI in eGFR decline in patients with SCT/D remains limited. We aimed to describe the relative risk for AKI in SCT/D and the effect of AKI on eGFR decline in SCT/D.

Methods

We performed a multi-center observational study of adult AA patients with a baseline eGFR ≥15 ml/min, and ≥1 year follow-up between 2005-2018. The presence of SCT/D (exposure) and normal hemoglobin phenotype (reference) was determined by hemoglobin electrophoresis. Outcomes of interest (incident All AKI [Kidney Disease: Improving Global Outcomes criteria], incident Severe AKI [doubling of baseline creatinine] and incident Sustained AKI [AKI persisting for ≥72 hours]) were adjudicated by chart review and evaluated by Cox regression. Only first AKI events were used. The effect of All AKI on eGFR decline (mixed linear models) was also investigated. Models were adjusted for predictors of AKI.

Results

We identified 8968 reference, 1279 SCT, and 254 SCD patients with a median follow-up of 7.6 years and mean serum creatinine of 0.8 mg/dl. SCT was associated with Sustained AKI (adjusted hazard ratio [aHR] 1.42; 95% CI, 1.08-1.88) compared to the reference. SCD was associated with All AKI (aHR 3.13; 95% CI, 2.33-4.21), Severe AKI (aHR 3.04; 95% CI, 1.90-4.87) and Sustained AKI (aHR 2.10; 95% CI, 1.24-3.53) compared to the reference. Effect of AKI on eGFR is shown in Figure 1.

Conclusion

The risk for AKI is increased in both SCT (Sustained) and SCD (all forms) and may contribute to faster eGFR decline in SCT/D. Further studies are needed to understand the mechanisms of AKI in SCT/D. Such studies will inform best practices that will help attenuate the burden of kidney disease in SCT/D.

Funding

  • Private Foundation Support