CHRONIC KIDNEY DISEASE AMONGST SICKLE CELL ANAEMIA PATIENT AT THE UNIVERSITY OF MAIDUGURI TEACHING HOSPITAL, NORTH EASTERN NIGERIA: A STUDY OF PREVALENCE AND RISK FACTORS

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Audu Abdullahi Bukar
Mohammad Maina Sulaiman
Adama Isa Ladu *
Aisha Mohammed Abba
Mohammed Kabir Ahmed
Gideon Thomas Marama
Usman Ali Medugu Abjah
(*) Corresponding Author:
Adama Isa Ladu | adamaisahladu@gmail.com

Abstract

ABSTRACT

Introduction: Involvement of the kidneys in patient with sickle cell anaemia is a well recognized chronic complication of this disorder. The index study seeks to determine the prevalence of chronic kidney disease in patients with homozygous sickle cell disease (HbSS) and to identify risk factors associated with its development.

Methodology: The subjects consisted of adolescents and adults with HbSS recruited sequentially from the adult haematology outpatient clinic and Day care ward of the unit. Clinical variables including age of diagnosis of SCA, frequency of vaso-occlusive crisis and transfusion therapy, as well as laboratory data including haematological profile, renal function test were obtained from routine blood result. The glomerular filtration rate was estimated (eGFR) using the ‘modification of diet in renal disease’ (MDRD) formula..

Results: Two hundred and eighty-four HbSS patients were recruited. The prevalence of CKD amongst them was 38.9%.  Further stratification of the patients based on eGFR showed that sixty-nine (26.8%) had hyperfiltration; 35 (13.6%) stage 1 CKD; 53 (20.6%) stage 2 CKD; 61 (23.7%) stage 3 CKD; 30 (11.7%) stage 4 CKD and 9 (3.5%) had end stage renal disease. There was significant association between eGFR and clinical parameters such as age (r -0.353, p=0.000), SBP (r -0.148, p= 0.021), DBP (r -0.213, p=0.001) and total number of blood received (r -0.276, p=0.000); and laboratory parameters such as  PCV (r 0.371, p=0.000); urea ( r 0.527, p=000 ); creatinine (r 0.625, p=0.000) and uric acid  ( r -0.419, p=0.000).

Conclusion

The present study has revealed a high prevalence of CKD amongst patients with SCA in this region. Various clinical and laboratory predictors of eGFR were also identified. Monitoring and detection of early stages of these groups of patients may allow for interventions which may delay progression into advance stages and ESRD.


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References

REFERENCES
1. Weatherall DJ. Genetic disorders of haemoglobin. In: Hoffbrand AV, Lewis SM, Tuddenham EGD (eds). Postgraduate Haematology 4th edition. Great Britain. Butterworth- Heinemann, 1999: 91-119.

2. Eaton WA, Hofrichter J. Sickle haemoglobin polymerization. Adv Protein Chem. 1990; 40:63.

3. Beutler E. The sickle cell diseases and related problems. In: Williams JW, Beutler E, Erslev AJ, Lichtman M (eds). Haematology 4th edition. New York: McGraw- Hill, 1990: 613- 644.

4. Noguchi CT, Schechter AN. Sickle haemoglobin polymerization in solution and in cells. Annual Review of Biophysics and Biophysical chemistry. 1985; 14: 239-263.

5. Mohandas N, Ross ME, Clark MR. Association between morphologic distortion of sickle cells and deoxygenation- induced cation permeability increase. Blood. 1986; 68 (2): 450-454.

6. Lew VL, Etzion Z, Bookchin RM. Dehydration response of sickle cells to sickling- induced Ca++ permeabilization. Blood. 2002; 99(7): 2578- 2585.

7. Akinola NO, Stevens SME, Franklin IM, Nash GB, Stuart J. Rheological changes in the prodromal and established phases of sickle cell vaso- occlusive crisis. British Journal of Haematology, 1992, 81: 598-602.

8. Bookchin RM, Lew VL. Pathophysiology of sickle cell anaemia. Haematology/ Oncology Clinic of North America. 1996; 10 (6): 1241-1254.

9. Flemming AF. The presentation, management and prevention of crises in sickle-cell disease in Africa. Blood rev. 1989; 31: 18–28.

10. Bainbridge R, Higgs DR, Maude GH, Serjeant GR. Clinical presentation of homozygous sickle cell disease. J pedtr. 1985; 106: 881.

11. Serjeant GR. Sickle cell disease. Oxford. Oxford University Press. 1992; 261.

12. Akinsola W, Odesanmi WO, Ogunniyi JO, and Ladipo GOA. Diseases causing chronic renal failure in Nigerians- a prospective study of 100 cases. Afr J Med Sci. 1989; 18(2): 131–137.

13. Ulasi II, Ijoma CK. The enormity of chronic kidney disease in Nigeria: The situation in a teaching hospital in south east Nigeria. Journal of Tropical Medicine. 2010.

14. Pham PT, Pham PC, Wilkinson AH, Lew SQ. Renal abnormalities in sickle cell disease. Kidney Int. 2000; 57: 1.

15. Saborio P, Scheinman JI. Sickle cell Nephropathy. J Am Soc Nephrol. 1999; 10: 187- 192.

16. Arogundade FA, Sanusi AA, Hassan MO, Salawu L, Durosinmi MA, Akinsola A (2010). An appraisal of renal dysfunction and its risk factors in patients with sickle cell disease. Nephron. Clin. Pract. 118: 225- 231.

17. Bolarinwa RA, Akinlade KS, Kuti M et al: Renal disease in adult Nigerians with sickle cell anaemia: a report of prevalence, clinical features and risk factors. Saudi J Kidney Dis. Transpl 2012, 23:171-175.

18. Powars DR, Elliot-Mills DD, Chan L, Hiti AL, Opas LM, Johnson C: chronic renal failure in sickle cell disease: Risk factors, clinical course and mortality. Ann Intern med 115: 614-620.

19. National Population Commission Federal republic of Nigeria. Nigeria Demographic and Health survey preliminary report. Calverton, Maryland, USA. Measure DHS, ICF macro, 2008; 17-24.

20. Ahmed SG, Kagu MB, Abjah UA, Bukar AA. (2012) Seasonal variations in the frequencies of acute vaso- occlusive Morbidities among sickle cell anaemia and patients in Northern Nigeria. Journal of Blood disorders and Transfusion. 01/2012; 3(120).

21. Levey AS, Bosch J, Lewis J, Greene T, Rogers N and Roth D. A more accurate ethod to estimate glomerular filtration rate from serum creatinine: a new prediction equation. Modification of Diet in Renal disease study group. Annals of internal medicine, 1999, 130, 461-470.

22. K/DOQI: Clinical practice guidelines for chronic kidney disease: evaluation, classification, and stratification. Am J Kidney Dis 2002; 39:S1–S266.

23. Wachukwu CM, Emem-Chioma PC, Wokoma FS, Oko-Jaja RI. Prevalence of risk factors for chronic kidney disease among adults in a university community in southern Nigeria. Pan African Medical Journal. 2015; 21:120 doi:10.11604/pamj.2015.21.120.7079.

24. Egbi OG, Okafor UH, Miebodei KE, Kasia BE, Kunle-Olowu OE, Unuigbe EI. Prevalence and correlates of chronic kidney disease among civil servants in Bayelsa state, Nigeria. Niger J Clin Pract 2014;17:602-7.

25. Geard A, Pule GD, Chemegni BC, Bitoungui VJN, Kengne AP, Chimusa ER et al. Clinical and genetic predictors of renal dysfunction in sickle cell anaemia in Cameroon. British Journal of Haematology, 2017; 178 : 629-639.

26. Aloni MN, Ngiyulu RM, Gini-Ehungu JL, Nsibu CN, Ekila MB and Lepira FB. Renal function in children suffering from sickle cell disease: challenge of early detection in highly resource-scarce settings. PLoS ONE, 2014,9,:1-5.

27. AI Ladu, AM Abba; 2017. A Review of Prevalence, Risk Factors and Clinical Significance of Microalbuminuria in Patients with Sickle Cell Anaemia. Sokoto Journal of Medical Laboratory Science, 2(2): 141 – 145.

28. Yusuf R, Hassan A, Ibrahim IN, Babadoko AA, Ibinaiye PO. Assessment of kidney function in sickle cell anemia patients in Zaria, Nigeria. Sahel Med J 2017; 20:21-5.

29. Aneke JC, Adegoke AO, Oyekunle AA, Osho PO, Sanusi AA and Okocha EC et al. Degrees of Kidney Disease in Nigerian Adults with Sickle-Cell Disease. Med Princ Pract 2014;23:271–274.

30. Clinical guideline 73: Chronic Kidney Disease. London, National Institute for Health and Clinical Excellence, 2008, pp 4.