Abstract: TH-PO1233
Redefining the Natural History and Management of Sickle Cell Kidney Disease (SCKD): Integration of Systematic Evidence with the American Society of Hematology Research Collaborative (ASH RC) Data Hub
Session Information
- Late-Breaking Research Posters
October 22, 2026 | Location: Exhibit Hall A, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Diversity and Equity in Kidney Health
- 900 Diversity and Equity in Kidney Health
Authors
- Saraf, Santosh, University of Illinois Chicago, Chicago, Illinois, United States
- Campbell, Kirk N., Penn Medicine, Philadelphia, Pennsylvania, United States
- Derebail, Vimal K., The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States
- Lebensburger, Jeffrey, The University of Alabama at Birmingham, Birmingham, Alabama, United States
- Sharpe, Claire C., King's College London, London, England, United Kingdom
- Ataga, Kenneth I., The University of Tennessee Health Science Center College of Medicine, Memphis, Tennessee, United States
- Seaman, Julia, Bayview Analytics, San Francisco, California, United States
- Allen, Isabel Elaine, University of California San Francisco, San Francisco, California, United States
- Romero, Alain J., Kidney Health Initiative, San Diego, California, United States
Group or Team Name
- on behalf of the KHI SCKD Project
Background
The study of SCKD has been limited by small cohorts and heterogeneous outcomes with short follow-up (F/U). The purposes of this 2-year project was to refine our understanding of SCKD through multicenter longitudinal electronic health records collected by the ASH RC.
Methods
The retrospective cohort was selected based on a confirmed diagnosis of SCD and ≥ 2 serum creatinine values over ≥6 months F/U censored to 9/30/2025. Univariate and multivariate analysis were performed using linear or logistic models adjusted for age, sex, baseline eGFR and hemoglobin [Hb] SS or Sβ0-thalassemia subtype.
Results
We identified 10,473 patients with 1.03 million total longitudinal patient-day observations and a median f/u of 9.28 years (IQR 6.54-11.88).
Mean annual eGFR decline was −1.18 mL/min* in children<18 (Schwartz) and −1.74 mL/min* in adults >18 (CKD-EPI2021). In children, eGFR increased (+3.2 ml/min*) until about age 10 and declined at a rate of -2.2 ml/min* thereafter. Albuminuria (ALB) steadily increased with age.
SCKD occurred in 26.3% of patients and 15.7% experienced worsening during F/U. Longitudinal trajectories showed early separation between the eGFR rate of decline in SCKD (-3.26 ml/min*) vs non-SCKD (-0.24 ml/min*), especially for the Hb SS or Sβ0 subtypes (67% of the SCD cohort). For those above the KDIGO A2 ALB (Kidney Disease Iimproving Global Outcome), the pediatric hyperfiltration had been more pronounced. In adults, an increase of +2.2mg/g per year in ALB was associated with an eGFR decline of -1.74 ml/min* and lower baseline Hb was independently associated with an eGFR loss of -0.20 mL/min* per g/dL of Hb.
69% of the patients were on opioids, 18% on nephroprotective drugs and 60% on Hydroxyurea.
*/BSA/year
Conclusion
The findings provide the largest quantitative description of SCKD progression to date. In adults, it suggests ALB as an early biomarker of eGFR decline. In pediatric settings hyperfiltration and ALB signal high risks of SCKD.
In future analyses, we intend to assess kidney outcomes in untreated matched controls and test various scenarios in quasi-intervention trials.
Acknowledgment
We are endebted to the KHI, the ASH RC and the members of the KHI SCKD project workgroups.
Funding
- Other U.S. Government Support