Renal Function in Infants with Sickle Cell Anemia

Baseline Data from the BABY HUG Trial

Russell E. Ware, Renee C. Rees, Sharada A. Sarnaik, Rathi V. Iyer, Ofelia A. Alvarez, James F Casella, Barry L. Shulkin, Eglal Shalaby-Rana, C. Frederic Strife, John H. Miller, Peter A. Lane, Winfred C. Wang, Scott T. Miller

Research output: Contribution to journalArticle

Abstract

Objectives: To examine the feasibility and accuracy of glomerular filtration rate (GFR) measurements in infants with sickle cell anemia (SCA). Study design: The NHLBI/NICHD-sponsored Phase III randomized double-blinded placebo-controlled trial (BABY HUG) tests the hypothesis that hydroxyurea can prevent chronic organ damage in SCA. GFR elevation is a coprimary endpoint, measured quantitatively by technetium 99m-labeled diethylenetriaminepentaacetic acid (DTPA) plasma clearance and estimated by the Schwartz equation with height and creatinine. Results: Baseline DTPA GFR measurement was attempted in 191 infants; 176 of 184 completed studies (96%) were interpretable. Average age (mean ± 1SD) was 13.7 ± 2.6 months. Average DTPA GFR was 125.2 ± 34.4 (range 40.2-300.9, normal 91.5 ± 17.8 mL/min/1.73m2), while Schwartz estimates were higher at 184.4 ± 55.5 mL/min/1.73m2. DTPA GFR was correlated with Schwartz GFR (r2 = 0.0658, P = .0012); also with age, weight, height, and kidney volume (all P <.002); but not with hemoglobin, HbF, white blood cell count, reticulocytes, medical events, or splenic function. Conclusions: Quantitative GFR measurement is feasible but variable among infants with SCA. Schwartz GFR estimates are not highly correlated with quantitative DTPA GFR values. Baseline GFR measurements suggest that renal dysfunction in SCA, evidenced by glomerular hyperfiltration, begins during infancy.

Original languageEnglish (US)
JournalJournal of Pediatrics
Volume156
Issue number1
DOIs
StatePublished - Jan 2010

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Sickle Cell Anemia
Glomerular Filtration Rate
Kidney
Acids
National Institute of Child Health and Human Development (U.S.)
National Heart, Lung, and Blood Institute (U.S.)
Hydroxyurea
Reticulocytes
Technetium
Leukocyte Count
Creatinine
Hemoglobins
Placebos
Weights and Measures

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

Cite this

Renal Function in Infants with Sickle Cell Anemia : Baseline Data from the BABY HUG Trial. / Ware, Russell E.; Rees, Renee C.; Sarnaik, Sharada A.; Iyer, Rathi V.; Alvarez, Ofelia A.; Casella, James F; Shulkin, Barry L.; Shalaby-Rana, Eglal; Strife, C. Frederic; Miller, John H.; Lane, Peter A.; Wang, Winfred C.; Miller, Scott T.

In: Journal of Pediatrics, Vol. 156, No. 1, 01.2010.

Research output: Contribution to journalArticle

Ware, RE, Rees, RC, Sarnaik, SA, Iyer, RV, Alvarez, OA, Casella, JF, Shulkin, BL, Shalaby-Rana, E, Strife, CF, Miller, JH, Lane, PA, Wang, WC & Miller, ST 2010, 'Renal Function in Infants with Sickle Cell Anemia: Baseline Data from the BABY HUG Trial', Journal of Pediatrics, vol. 156, no. 1. https://doi.org/10.1016/j.jpeds.2009.06.060
Ware, Russell E. ; Rees, Renee C. ; Sarnaik, Sharada A. ; Iyer, Rathi V. ; Alvarez, Ofelia A. ; Casella, James F ; Shulkin, Barry L. ; Shalaby-Rana, Eglal ; Strife, C. Frederic ; Miller, John H. ; Lane, Peter A. ; Wang, Winfred C. ; Miller, Scott T. / Renal Function in Infants with Sickle Cell Anemia : Baseline Data from the BABY HUG Trial. In: Journal of Pediatrics. 2010 ; Vol. 156, No. 1.
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AU - Iyer, Rathi V.

AU - Alvarez, Ofelia A.

AU - Casella, James F

AU - Shulkin, Barry L.

AU - Shalaby-Rana, Eglal

AU - Strife, C. Frederic

AU - Miller, John H.

AU - Lane, Peter A.

AU - Wang, Winfred C.

AU - Miller, Scott T.

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N2 - Objectives: To examine the feasibility and accuracy of glomerular filtration rate (GFR) measurements in infants with sickle cell anemia (SCA). Study design: The NHLBI/NICHD-sponsored Phase III randomized double-blinded placebo-controlled trial (BABY HUG) tests the hypothesis that hydroxyurea can prevent chronic organ damage in SCA. GFR elevation is a coprimary endpoint, measured quantitatively by technetium 99m-labeled diethylenetriaminepentaacetic acid (DTPA) plasma clearance and estimated by the Schwartz equation with height and creatinine. Results: Baseline DTPA GFR measurement was attempted in 191 infants; 176 of 184 completed studies (96%) were interpretable. Average age (mean ± 1SD) was 13.7 ± 2.6 months. Average DTPA GFR was 125.2 ± 34.4 (range 40.2-300.9, normal 91.5 ± 17.8 mL/min/1.73m2), while Schwartz estimates were higher at 184.4 ± 55.5 mL/min/1.73m2. DTPA GFR was correlated with Schwartz GFR (r2 = 0.0658, P = .0012); also with age, weight, height, and kidney volume (all P <.002); but not with hemoglobin, HbF, white blood cell count, reticulocytes, medical events, or splenic function. Conclusions: Quantitative GFR measurement is feasible but variable among infants with SCA. Schwartz GFR estimates are not highly correlated with quantitative DTPA GFR values. Baseline GFR measurements suggest that renal dysfunction in SCA, evidenced by glomerular hyperfiltration, begins during infancy.

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