Kidney Week

Abstract: TH-PO596

Primary Hypertension in Patients With Sickle Cell: Observations From an Adult Sickle Cell Kidney Disease Clinic

Session Information

• Hypertension and CVD: Epidemiology, Risk Factors, Prevention
  November 03, 2022 | Location: Exhibit Hall, Orange County Convention Center‚ West Building
  Abstract Time: 10:00 AM - 12:00 PM

Category: Hypertension and CVD

• 1501 Hypertension and CVD: Epidemiology‚ Risk Factors‚ and Prevention

Authors

• Keyes, Jonathan, Emory University School of Medicine, Atlanta, Georgia, United States

Jonathan Keyes,

• Ajiboye, Oyintayo, Emory University School of Medicine, Atlanta, Georgia, United States

Oyintayo Ajiboye,

• Kalantri, Pooja, Emory University School of Medicine, Atlanta, Georgia, United States

Pooja Kalantri,

• Amarapurkar, Pooja D., Emory University School of Medicine, Atlanta, Georgia, United States

Pooja D. Amarapurkar,

Background

Patients with Sickle Cell Disease (SCD) have lower blood pressures (BP). Relative hypertension (HTN) increases the risk for stroke, pulmonary HTN, and kidney dysfunction in SCD patients. Limited data exists about the prevalence of HTN in SCD population. We describe our observations from an adult SCD kidney clinic.

Methods

We performed a retrospective chart review of patients seen in the SCD kidney clinic at the Georgia Comprehensive Center between January 2021 to December 2021. Demographics, clinical characteristics, albuminuria, estimated glomerular filtration rate (eGFR), BP trends, number of antihypertensive medications, correlation of BP with albuminuria, eGFR and hyperkalemia were noted. Data analyses were generated using R-statistical software.

Results

During the study period 44 African American patients, 28 (64%) females and 16 (36%) males, with SCD were enrolled. The median age was 45 years. The sickle cell phenotypes were predominantly SS 38 (86%) [SC 4 (9.1%), hemoglobin S/high fetal hemoglobin 1 (2.3%), and sickle cell beta thalassemia 1 (2.3%)]. HTN was present in 23 (52%) patients. Median albumin to creatinine ratio (ACR) was 330 mg/g creatinine (IQR 75-941). ACR>300 was present in 14 (61%) patients with HTN and 9 (43%) without (p=0.23). The median eGFR at initial visit was 59ml/min/1.73m² (IQR 38-106). eGFR<60 mL/min was present in 12 (52%) with HTN and 4 (19%) without. Hyperkalemia (>5.5mg/dl) was present in 8 (35%) with HTN and 6 (29%) without HTN. The systolic BP range was 114-185. The diastolic BP range was 65-110. Of those with HTN, 16 (70%) were on angiotensin converting enzyme inhibitors (ACEI) or angiotensin receptor blockers (ARB), 7 (30%) on diuretics, 9 (39%) on calcium channel blockers, 10 (43%) on a combination of 2 medications.

Conclusion

Our study is unique in that 52% of our SCD patients had HTN on presentation. We observed a correlation between HTN, albuminuria, and decreased eGFR. Optimal HTN management is crucial but challenging. Diuretics can increase the risk of sickle crisis while ACEI/ARB may contribute to hyperkalemia. Further studies are needed to assess the epidemiology of HTN and determine optimal BP regimens for patients with SCD.