Early Markers of Chronic Kidney Disease Among Children in Steady-state Sickle Cell Anemia in Rivers State, Southern Nigeria: A Comparative Study

Abstract

Abstract Aim: We aimed to determine the status of early markers of chronic kidney disease (CKD) among children with steady-state sickle cell anemia (SCA) in southern, Nigeria. Materials and Methods: This comparative cross-sectional study randomly enrolled 60 hemoglobin SS-genotype (HbSS, SCA group) and 60 hemoglobin AA-genotype (HbAA, non-SCA group) children and their markers of early CKD were compared. Microalbuminuria was defined as spot urine albumin–creatinine ratio 30–<300 mg/g, hyperfiltration was glomerular filtration rate (GFR) ≥2 standard deviations from the mean estimated GFR for the non-SCA group and steady-state SCA was the absence of infection, pain, acute clinical symptoms, or crisis for ≥3 months. Results: Of the 120 children studied, 62 (51.7%) were males. The mean age was 9.36 ± 4.06 years (range: 3–16 years). The markers of CKD were higher in the SCA group than in the non-SCA group: Hyperfiltration (HbSS 25.0% vs. HbAA 6.7%, P = 0.002) and microalbuminuria (HbSS 16.7% vs. HbAA 3.3%; P = 0.015), respectively. The SCA group had four [adjusted odds ratio (AOR) = 4.67; 95% confidence interval (CI) = 1.44–15.04] and five (AOR = 5.80; 95% CI = 1.29–26.03) times increased odds of hyperfiltration and microalbuminuria compared with the non-SCA group. Hypertension was significantly higher among the non-SCA group than that of the SCA group (HbAA 16.7% vs. HbSS 1.7%; P = 0.004). Conclusions: The early markers of CKD are notably higher among children with SCA disease in southern Nigeria even during periods of apparent health. Therefore, early screening to identify subclinical CKD in our setting is necessary.