Association of sickle cell trait with chronic kidney disease and albuminuria in African Americans.

JAMA
Authors
Keywords
Abstract

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 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.

Year of Publication
2014
Journal
JAMA
Volume
312
Issue
20
Pages
2115-25
Date Published
2014 Nov 26
ISSN
1538-3598
URL
DOI
10.1001/jama.2014.15063
PubMed ID
25393378
PubMed Central ID
PMC4356116
Links
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U01 DK085501 / DK / NIDDK NIH HHS / United States
HHSN268201100012C / HL / NHLBI NIH HHS / United States
K08 HL125100 / HL / NHLBI NIH HHS / United States
RC2 HL102419 / HL / NHLBI NIH HHS / United States
HHSN268201100001I / HL / NHLBI NIH HHS / United States
HHSN268201100009I / HL / NHLBI NIH HHS / United States
RC2 HL102923 / HL / NHLBI NIH HHS / United States
N01-HC-95162 / HC / NHLBI NIH HHS / United States
R01 DK102134 / DK / NIDDK NIH HHS / United States
5K12 HL087097-0 / HL / NHLBI NIH HHS / United States
N01HC95160 / HL / NHLBI NIH HHS / United States
5RC2HL102419 / HL / NHLBI NIH HHS / United States
U54 HG003067 / HG / NHGRI NIH HHS / United States
HHSN268201300049C / PHS HHS / United States
R01 HL107816 / HL / NHLBI NIH HHS / United States
1R01DK102134-01 / DK / NIDDK NIH HHS / United States
U01 DK085524 / DK / NIDDK NIH HHS / United States
RC2 HL102926 / HL / NHLBI NIH HHS / United States
R01HL59367 / HL / NHLBI NIH HHS / United States
HHSN268201100010C / HL / NHLBI NIH HHS / United States
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RC4 MD005964 / MD / NIMHD NIH HHS / United States
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RC2 HL-102924 / HL / NHLBI NIH HHS / United States
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DK085545 / DK / NIDDK NIH HHS / United States
HHSN268201100007C / PHS HHS / United States
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HHSN268201100009C / HL / NHLBI NIH HHS / United States
HHSN268201100011C / PHS HHS / United States
HSN268201300026C / PHS HHS / United States
HHSN268201100005C / HL / NHLBI NIH HHS / United States
T32HL007208 / HL / NHLBI NIH HHS / United States
HHSN268201100046C / PHS HHS / United States
RC2 HL103010 / HL / NHLBI NIH HHS / United States
HHSN268201100007I / HL / NHLBI NIH HHS / United States
N01-HC-95161 / HC / NHLBI NIH HHS / United States
UL1 TR000040 / TR / NCATS NIH HHS / United States
HHSN268201300046C / HL / NHLBI NIH HHS / United States
HHSN268201300027C / PHS HHS / United States
HHSN268201100002I / HL / NHLBI NIH HHS / United States
HL080494-05 / HL / NHLBI NIH HHS / United States
N01HC95166 / HL / NHLBI NIH HHS / United States
HHSN268201100006C / PHS HHS / United States
HHSN268201300029C / HL / NHLBI NIH HHS / United States
N01-HC-95166 / HC / NHLBI NIH HHS / United States
R01 HL087641 / HL / NHLBI NIH HHS / United States
HHSN268201100002C / PHS HHS / United States
R01 DK076770-01 / DK / NIDDK NIH HHS / United States
HHSN268201100001C / WH / WHI NIH HHS / United States
RC2 HL-103010 / HL / NHLBI NIH HHS / United States
RC2 HL102925 / HL / NHLBI NIH HHS / United States
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N01-HC-95167 / HC / NHLBI NIH HHS / United States
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