Acid-Base Status of Adults with Sickle-cell Anaemia

Kong, Hongwei; Alleyne, George A.O.

doi:10.1136/bmj.3.5665.271

Cited by 17 publications

(2 citation statements)

References 5 publications

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“…Metabolic acidosis was defined by serum bicarbonate <22 mmol/L, and we lacked blood pH measurements. Our definition may have included compensatory metabolic acidosis due to respiratory alkalosis, a known feature of SCD (29), although a prior study demonstrated that low serum bicarbonate in patients with SCD is associated with a low pH but not with a low arterial partial pressure of carbon dioxide (5). We did not have measurements of urine anion gap or NH 4 excretion, and this will also need to be investigated in prospective studies.…”

Section: Discussionmentioning

confidence: 99%

Hyperkalemia and Metabolic Acidosis Occur at a Higher eGFR in Sickle Cell Disease

et al. 2022

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Background: People with sickle cell disease (SCD) have an elevated estimated glomerular filtration rate (eGFR) compared to the general population and this may alter the usual creatinine-based eGFR cutoffs for which physiologic evidence of kidney dysfunction is apparent. This study aimed to identify eGFR thresholds for hyperkalemia and metabolic acidosis in patients with SCD Methods: This was a cross-sectional analysis of 733 patients with severe (hemoglobin SS or Sβ0-thalassemia) SCD genotype, 238 patients with moderate (hemoglobin SC or Sβ+-thalassemia) SCD genotype, and 1,333 age- and sex-matched African Americans from the National Health and Nutrition Examination Survey (NHANES). The prevalence of hyperkalemia and metabolic acidosis were compared by eGFR category. Cutoffs for hyperkalemia and metabolic acidosis were determined using generalized additive models. Results: Hyperkalemia and metabolic acidosis were more common in those with severe SCD genotype (13% and 21%, respectively) compared to in NHANES (0.3% and 5%, respectively); the prevalence rates in the moderate SCD genotype were intermediate for hyperkalemia (3%) and metabolic acidosis (11%). The proportion of patients with hyperkalemia and metabolic acidosis progressively increased with lower eGFR category in both SCD genotype groups. The eGFR thresholds for hyperkalemia and metabolic acidosis were higher in the severe (85 and 91 mL/min/1.73m2, respectively) and moderate (52 and 102 mL/min/1.73m2, respectively) SCD genotypes compared with NHANES (34 and 46 mL/min/1.73m2). Conclusions: We demonstrate that hyperkalemia and metabolic acidosis are more common and occur at higher eGFR values in patients with SCD compared to age- and sex-matched African Americans, including in eGFR ranges considered to be normal. Future studies using redefined creatinine-based eGFR thresholds for abnormal kidney function may identify high-risk patients for earlier intervention strategies and referral for specialized renal care in SCD.

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Section: Discussionmentioning

confidence: 99%

Hyperkalemia and Metabolic Acidosis Occur at a Higher eGFR in Sickle Cell Disease

et al. 2022

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“…During the 1960s and 1970s, alkalinization with sodium bicarbonate was briefly in vogue, 9 25 45 64 65 but the practice was discontinued 65 when no benefit was detected. 43…”

Section: Avoiding Of Sickling Exacerbationsmentioning

confidence: 99%

Anaesthesia for peculiar cells'a century of sickle cell disease

Firth

2005

British Journal of Anaesthesia

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Sickle cell disease is a congenital haemoglobinopathy with a high incidence of perioperative complications. Traditional anaesthetic management, based largely on extrapolation from biochemical models, has emphasized avoidance of red cell sickling to prevent exacerbations of the disease. This historical review outlines the evolution of the traditional approach to sickle cell pathology, assesses the validity of this model, describes the emergence of the concept of the disease as one defined by chronic inflammatory vascular damage, and outlines the practical implications of this new approach.

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The Treatment of Sickle Cell Anemia

Charache¹

1974

Arch Intern Med

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Acid-Base Status of Adults with Sickle-cell Anaemia

Cited by 17 publications

References 5 publications

Hyperkalemia and Metabolic Acidosis Occur at a Higher eGFR in Sickle Cell Disease

Hyperkalemia and Metabolic Acidosis Occur at a Higher eGFR in Sickle Cell Disease

Anaesthesia for peculiar cells'a century of sickle cell disease

The Treatment of Sickle Cell Anemia

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