Kidney Week

Abstract: SA-PO0686

Determinants of eGFR Decline in Sickle Cell Disease: A Systematic Review of Albuminuria (Alb) and Longitudinal Risk Factors

Session Information

• Glomerular Diseases: Clinical, Outcomes, and Therapeutics Research - Other
  October 24, 2026 | Location: Exhibit Hall A, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Glomerular Diseases

• 1402 Glomerular Diseases: Clinical, Outcomes, and Therapeutics

Authors

• Romero, Alain J., University of California San Diego, La Jolla, California, United States

Alain J. Romero, PharmD, PhD

• Saraf, Santosh, University of Illinois Hospital & Health Sciences System, Chicago, Illinois, United States

Santosh Saraf, MD

• Ataga, Kenneth I., The University of Tennessee Health Science Center College of Medicine, Memphis, Tennessee, United States

Kenneth I. Ataga, MBBS

• Derebail, Vimal K., The University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, United States

Vimal K. Derebail, MD, MPH, FASN

• Campbell, Kirk N., University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, United States

Kirk N. Campbell, MD, FASN

• Sharpe, Claire C., University of Nottingham, Nottingham, England, United Kingdom

Claire C. Sharpe, MBBS, PhD

• Lebensburger, Jeffrey, The University of Alabama at Birmingham, Birmingham, Alabama, United States

Jeffrey Lebensburger, DO, MPH

Background

Sickle cell disease (SCD)–associated kidney disease (SCKD) is a leading cause of morbidity, yet determinants of eGFR decline remain incompletely defined. Alb is widely used but its predictive value for longitudinal eGFR decline has not been yet quantified in SCKD.

Methods

We conducted a systematic review of studies in SCKD, including randomized trials, prospective cohorts, and retrospective analyses. We applied PRISMA guidelines to identify publications of SCKD natural history (Fig.1). Outcomes included eGFR slope, CKD progression, and Alb. Qualitative synthesis assessed consistency and strength of associations with feasibility for meta-analysis.

Results

289 studies were identified including approximately 15 prospective, longitudinal cohorts. Direct eGFR slope data were limited. Across studies, mean eGFR decline ranged from 1 to 2.36 mL/min/1.73m²/year, with accelerated decline (>3 mL/min/1.73m²/year) observed in high-risk subgroups.
Alb emerged as the most consistent predictor of kidney disease progression, with persistent albuminuria associated with faster eGFR decline and incident CKD. An increase in hemolysis key markers were consistently associated with Alb/P, potentially supporting a mechanistic link between hemolysis and renal injury.
Pediatric cohorts demonstrated early hyperfiltration, suggesting a biphasic trajectory; however, longitudinal linkage to adult CKD outcomes remains limited.

Conclusion

Alb is a robust predictor of eGFR decline in SCD, with additional contributions from hemolysis and hyperfiltration in pediatric populations. Evidence is limited by heterogeneous study designs and sparse longitudinal slope data but meta analysis is feasible to quantify effect size for alb. Characterization, standardized endpoints and longitudinal data are needed to support future nephroprotective strategies.

Acknowledgment

KHI WorkGroups

Funding

• Other U.S. Government Support