High Prevalence of Sickle Cell Trait in African Americans with ESRD

Derebail, Vimal K.; Nachman, Patrick H.; Key, Nigel S.; Ansede, Heather; Falk, Ronald J.; Kshirsagar, Abhijit V.

doi:10.1681/asn.2009070705

Cited by 70 publications

(86 citation statements)

References 22 publications

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“…The well recognized renal manifestations of sickle cell trait have led to speculation that HbAS could contribute to development of CKD and progression to maintenance dialysis. [9][10][11]19 The present study, which shows a higher prevalence of sickle cell trait in the ESRD population, supports this hypothesis. However, we acknowledge that the contribution of sickle cell trait to CKD progression would ideally be studied in a prospective cohort.…”

Section: Discussionsupporting

confidence: 80%

“…Compared with prior prevalence estimates in the general population, HbAS was more common in dialysis-dependent CKD (10.2% versus 6.5%-8.6%, P,0.001; versus 8.7%, P=0.02). 1,2,9,[15][16][17][18] Compared with AfricanAmerican dialysis patients, HbAS was more common than in the study by Hicks et al 18 (7.9%, P=0.003) and less common than in our prior study (14.9%, P=0.04). 9 HbAC in our cohort was more common compared with one population study (2.4% versus 1.7%, P=0.003), 17 but similar to other reports (2.2%-2.4%, P=NS), 1,2 and it was less prevalent than in our prior study of dialysis patients (2.4% versus 4.8%, P=0.04).…”

Section: Resultscontrasting

confidence: 48%

“…A prior study of African-American dialysis patients from four North Carolina centers detected an even higher prevalence of 14.9%. 9 This largest study to date reports a prevalence in between our prior study and the lowest reported prevalence (7.9%) in dialysis-dependent CKD. 18 Reasons for differences between these studies are not immediately apparent.…”

Section: Discussionmentioning

confidence: 74%

“…9 HbAC in our cohort was more common compared with one population study (2.4% versus 1.7%, P=0.003), 17 but similar to other reports (2.2%-2.4%, P=NS), 1,2 and it was less prevalent than in our prior study of dialysis patients (2.4% versus 4.8%, P=0.04). 9 For ESA dosing, we excluded 317 (9.2% HbAS and 2.8% HbAC) patients who received no ESA or for whom ESA dosing was missing. Including these patients as zero doses would bias the results to a greater difference, because there were proportionately more of them in the normal hemoglobin (HbAA) group.…”

Section: Resultsmentioning

confidence: 99%

“…Although not conclusive, some epidemiologic data support this contention in CKD patients, particularly patients requiring maintenance dialysis. [8][9][10][11] The anemia of CKD is a specific instance in which hemoglobinopathy traits may have an impact. Uremic toxins alter erythrocytes, and transit through an extracorporeal hemodialysis circuit could predispose to sickling of red blood cells containing HbAS.…”

mentioning

confidence: 99%

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Sickle Trait in African-American Hemodialysis Patients and Higher Erythropoiesis-Stimulating Agent Dose

Derebail¹,

Lacson

Kshirsagar³

et al. 2014

Journal of the American Society of Nephrology

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African Americans require higher doses of erythropoiesis-stimulating agents (ESAs) during dialysis to manage anemia, but the influence of sickle cell trait and other hemoglobinopathy traits on anemia in dialysis patients has not been adequately evaluated. We performed a cross-sectional study of a large cohort of adult African-American hemodialysis patients in the United States to determine the prevalence of hemoglobinopathy traits and quantify their influence on ESA dosing. Laboratory and clinical data were obtained over 6 months in 2011. Among 5319 African-American patients, 542 (10.2%) patients had sickle cell trait, and 129 (2.4%) patients had hemoglobin C trait; no other hemoglobinopathy traits were present. Sickle cell trait was more common in this cohort than the general African-American population (10.2% versus 6.5%-8.7%, respectively, P,0.05). Among 5002 patients (10.3% sickle cell trait and 2.4% hemoglobin C trait) receiving ESAs, demographic and clinical variables were similar across groups, with achieved hemoglobin levels being nearly identical. Patients with hemoglobinopathy traits received higher median doses of ESA than patients with normal hemoglobin (4737.4 versus 4364.1 units/treatment, respectively, P=0.02). In multivariable analyses, hemoglobinopathy traits associated with 13.2% more ESA per treatment (P=0.001). Within subgroups, sickle cell trait patients received 13.2% (P=0.003) higher dose and hemoglobin C trait patients exhibited a similar difference (12.9%, P=0.12). Sensitivity analyses using weight-based dosing definitions and separate logistic regression models showed comparable associations. Our findings suggest that the presence of sickle cell trait and hemoglobin C trait may explain, at least in part, prior observations of greater ESA doses administered to African-American dialysis patients relative to Caucasian patients.

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Section: Discussionsupporting

confidence: 80%

Section: Resultscontrasting

confidence: 48%

Section: Discussionmentioning

confidence: 74%

Section: Resultsmentioning

confidence: 99%

mentioning

confidence: 99%

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Sickle Trait in African-American Hemodialysis Patients and Higher Erythropoiesis-Stimulating Agent Dose

Derebail¹,

Lacson

Kshirsagar³

et al. 2014

Journal of the American Society of Nephrology

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Association of Sickle Cell Trait With Chronic Kidney Disease and Albuminuria in African Americans

Naik

Derebail

Grams

et al. 2014

JAMA

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173

192

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IMPORTANCE The association between sickle cell trait (SCT) and chronic kidney disease (CKD) is uncertain. OBJECTIVE To describe the relationship between SCT and CKD and albuminuria in self-identified African Americans. DESIGN, SETTING, AND PARTICIPANTS Using 5 large, prospective, US population-based studies (the Atherosclerosis Risk in Communities Study [ARIC, 1987–2013; n = 3402], Jackson Heart Study [JHS, 2000–2012; n = 2105], Coronary Artery Risk Development in Young Adults [CARDIA, 1985–2006; n = 848], Multi-Ethnic Study of Atherosclerosis [MESA, 2000–2012; n = 1620], and Women’s Health Initiative [WHI, 1993–2012; n = 8000]), we evaluated 15 975 self-identified African Americans (1248 participants with SCT [SCT carriers] and 14 727 participants without SCT [noncarriers]). MAIN OUTCOMES AND MEASURES Primary outcomes were CKD (defined as an estimated glomerular filtration rate [eGFR] of <60 mL/min/1.73 m2 at baseline or follow-up), incident CKD, albuminuria (defined as a spot urine albumin:creatinine ratio of >30 mg/g or albumin excretion rate >30 mg/24 hours), and decline in eGFR (defined as a decrease of >3 mL/min/1.73 m2 per year). Effect sizes were calculated separately for each cohort and were subsequently meta-analyzed using a random-effects model. RESULTS A total of 2233 individuals (239 of 1247 SCT carriers [19.2%] vs 1994 of 14 722 noncarriers [13.5%]) had CKD, 1298 (140 of 675 SCT carriers [20.7%] vs 1158 of 8481 noncarriers [13.7%]) experienced incident CKD, 1719 (150 of 665 SCT carriers [22.6%] vs 1569 of 8249 noncarriers [19.0%]) experienced decline in eGFR, and 1322 (154 of 485 SCT carriers [31.8%] vs 1168 of 5947 noncarriers [19.6%]) had albuminuria during the study period. Individuals with SCT had an increased risk of CKD (odds ratio [OR], 1.57 [95% CI, 1.34–1.84]; absolute risk difference [ARD], 7.6% [95% CI, 4.7%–10.8%]), incident CKD (OR, 1.79 [95% CI, 1.45–2.20]; ARD, 8.5% [95% CI, 5.1%–12.3%]), and decline in eGFR (OR, 1.32 [95% CI, 1.07–1.61]; ARD, 6.1% [95% CI, 1.4%–13.0%]) compared with noncarriers. Sickle cell trait was also associated with albuminuria (OR, 1.86 [95% CI, 1.49–2.31]; ARD, 12.6% [95% CI, 7.7%–17.7%]). CONCLUSIONS AND RELEVANCE Among African Americans in these cohorts, the presence of SCT was associated with an increased risk of CKD, decline in eGFR, and albuminuria, compared with noncarriers. These findings suggest that SCT may be associated with the higher risk of kidney disease in African Americans.

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Association of Sickle Cell Trait With Incidence of Coronary Heart Disease Among African American Individuals

et al. 2021

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IMPORTANCEThe incidence of and mortality from coronary heart disease (CHD) are substantially higher among African American individuals compared with non-Hispanic White individuals, even after adjusting for traditional factors associated with CHD. The unexplained excess risk might be due to genetic factors related to African ancestry that are associated with a higher risk of CHD, such as the heterozygous state for the sickle cell variant or sickle cell trait (SCT). OBJECTIVE To evaluate whether there is an association between SCT and the incidence of myocardial infarction (MI) or composite CHD outcomes in African American individuals. DESIGN, SETTING, AND PARTICIPANTSThis cohort study included 5 large, prospective, population-based cohorts of African American individuals in the Women's Health Initiative (WHI) study, the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study, the Multi-Ethnic Study of Atherosclerosis (MESA), the Jackson Heart Study (JHS), and the Atherosclerosis Risk in Communities (ARIC) study. The follow-up periods included in this

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High Prevalence of Sickle Cell Trait in African Americans with ESRD

Cited by 70 publications

References 22 publications

Sickle Trait in African-American Hemodialysis Patients and Higher Erythropoiesis-Stimulating Agent Dose

Sickle Trait in African-American Hemodialysis Patients and Higher Erythropoiesis-Stimulating Agent Dose

Association of Sickle Cell Trait With Chronic Kidney Disease and Albuminuria in African Americans

Association of Sickle Cell Trait With Incidence of Coronary Heart Disease Among African American Individuals

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