| dc.description.abstract | Background: Improved medical care has led to improved life expectancy of sickle cell
anaemia (SCA) patients hence complications associated with SCA such as chronic
kidney disease (CKD) are being seen more frequently. Globally, nephropathy of
varying severity occurs in 5 to 18 % of the SCA population across all age groups with a
third of the adults proceeding to develop CKD while over 30 % of paediatric SCA
patients have been documented to have CKD in Africa. The mortality rate in SCA
patients CKD is high. This study sought to determine the prevalence and risk factors of
CKD in SCA, information which was not available in Zambia prior to this study. This
information will guide in targeting and timing of screening for CKD in SCA in
children in our population
Objectives: To determine prevalence of haematuria, proteinuria, abnormal estimated
glomerular filtration rate (eGFR) and CKD and risk factors of CKD among the steady
state SCA patients aged 5 to 16 years at the University Teaching Hospital (UTH),
Lusaka.
Methodology: This was a prospective cross - sectional study of 197 children aged
5 to 16 years with SCA at the UTH - Lusaka conducted from August 2014 to July 2015.
Demographic and clinical data were collected using a structured questionnaire. Urine
and blood samples were used to determine the urine albumin creatinine ratio (ACR) and
full blood count /blood biochemistry respectively. CKD was defined and determined
using the Kidney Disease Outcome Quality Initiative 2012 guidelines employing urine
ACR, dipstick urinalysis and eGFR. In this study, spot urine ACR and dipstick
urinalysis were done and repeated three months later if initial tests were abnormal. Data
was analysed using SPSS version 21. Chi square and t test were used to compare
proportions between groups. Relation between study variables and CKD were examined
using logistic regression
Results: The median age of the participants was 9 years (range 9 - 12.3 years). Male to
female ratio was 1:1. The mean age at diagnosis of SCA was 22 months.
v
The prevalence of haematuria, proteinuria and CKD among the study participants was
14.2%, 36% and 36 % respectively. Low haemoglobin and elevated mean corpuscular
volume (MCV) were associated with CKD-AOR 0.62, 95% CI; 0.46-0.84 and 1.04, 95%
CI; 1.01 – 1.08 respectively. Recurrent admissions (due to VOCs, severe anaemia and
febrile illness) were also risk factors associated with CKD- AOR 0.52, 95% CI; 0.27-
0.98. CKD was not associated with age at enrolment, sex, age at diagnosis of SCA,
recurrent Vaso-occlusive crisis (VOCs) or abnormal liver function tests.
Conclusion: The prevalence of CKD among the SCA patients at UTH- Lusaka is high
(36%) with lower Haemoglobin, elevated MCV and recurrent admissions being risk
factors for developing CKD. SCA patients should be screened for CKD routinely at
least once a year. Interventions such as early introduction of hydroxyurea, proactive
blood transfusions and ACE inhibitors can reduce the risk of CKD and its progression
to end stage renal disease.
Key words: Chronic kidney disease, sickle cell anaemia, Nephropathy. | en |
