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Open Access Research article

Determination of the best method to estimate glomerular filtration rate from serum creatinine in adult patients with sickle cell disease: a prospective observational cohort study

Jean-Benoît Arlet1, Jean-Antoine Ribeil2, Gilles Chatellier3, Dominique Eladari4, Sophie De Seigneux5, Jean-Claude Souberbielle6, Gérard Friedlander7, Marianne de Montalembert8, Jacques Pouchot1, Dominique Prié6 and Marie Courbebaisse69*

Author Affiliations

1 Service de Médecine Interne, centre de référence des syndromes drépanocytaires majeurs, Faculté de médecine Paris Descartes et Assistance publique – Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Cedex 15, Paris, 75908, France

2 Département de Biothérapie, centre de référence des syndromes drépanocytaires majeurs, Faculté de médecine Paris Descartes et Assistance publique – Hôpitaux de Paris, Hôpital Necker Enfants Malades, 161, rue de Sèvres, 75015 Paris Cedex 15, Paris, France, 75908, France

3 Faculté de médecine Paris Descartes et CIC-EC4 INSERM, Assistance publique – Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Cedex 15, Paris, 75908, France

4 Service d’Explorations Fonctionnelles. Faculté de médecine Paris Descartes, INSERM U872 et Assistance publique –Hôpitaux de Paris, Hôpital Européen Georges Pompidou, 20, rue Leblanc, Cedex 15, Paris, 75908, France

5 Service de Néphrologie, Hôpital Cantonal de Genève, 4 rue Perret Gentil, Genève 4, Suisse, 1211, Switzerland

6 Service d’Explorations Fonctionnelles. Faculté de médecine Paris Descartes, INSERM U845 et Assistance publique –Hôpitaux de Paris, Hôpital Necker Enfants Malades, 161, rue de Sèvres, 75015 Paris, Cedex 15, France, Paris, 75908, France

7 Service d’Explorations Fonctionnelles. Faculté de médecine Paris Descartes, INSERM U845 et Assistance publique –Hôpitaux de Paris, Hôpital Européen Georges Pompidou, 20, rue Leblanc Cedex 15, Paris, 75908, France

8 Service de Pédiatrie Générale, Assistance publique –Hôpitaux de Paris, Hôpital Necker Enfants Malades, 161, rue de Sèvres, 75015 Paris, Cedex 15, France, Paris, 75908, France

9 Hôpital Européen Georges Pompidou, 20, rue Leblanc, Cedex 15, Paris, 75908, France

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BMC Nephrology 2012, 13:83  doi:10.1186/1471-2369-13-83

Published: 6 August 2012

Abstract

Background

Sickle cell disease (SCD) leads to tissue hypoxia resulting in chronic organ dysfunction including SCD associated nephropathy. The goal of our study was to determine the best equation to estimate glomerular filtration rate (GFR) in SCD adult patients.

Methods

We conducted a prospective observational cohort study. Since 2007, all adult SCD patients in steady state, followed in two medical departments, have had their GFR measured using iohexol plasma clearance (gold standard). The Cockcroft-Gault, MDRD-v4, CKP-EPI and finally, MDRD and CKD-EPI equations without adjustment for ethnicity were tested to estimate GFR from serum creatinine. Estimated GFRs were compared to measured GFRs according to the graphical Bland and Altman method.

Results

Sixty-four SCD patients (16 men, median age 27.5 years [range 18.0-67.5], 41 with SS-genotype were studied. They were Sub-Saharan Africa and French West Indies natives and predominantly lean (median body mass index: 22 kg/m2 [16-33]). Hyperfiltration (defined as measured GFR >110 mL/min/1.73 m2) was detected in 53.1% of patients. Urinary albumin/creatinine ratio was higher in patients with hyperfiltration than in patients with normal GFR (4.05 mg/mmol [0.14-60] versus 0.4 mg/mmol [0.7-81], p = 0.01). The CKD-EPI equation without adjustment for ethnicity had both the lowest bias and the greatest precision. Differences between estimated GFRs using the CKP-EPI equation and measured GFRs decreased with increasing GFR values, whereas it increased with the Cockcroft-Gault and MDRD-v4 equations.

Conclusions

We confirm that SCD patients have a high rate of glomerular hyperfiltration, which is frequently associated with microalbuminuria or macroalbuminuria. In non-Afro-American SCD patients, the best method for estimating GFR from serum creatinine is the CKD-EPI equation without adjustment for ethnicity. This equation is particularly accurate to estimate high GFR values, including glomerular hyperfiltration, and thus should be recommended to screen SCD adult patients at high risk for SCD nephropathy.

Keywords:
Sickle cell disease; Glomerular hyperfiltration; Albuminuria; Glomerular filtration rate; CKD-EPI equation; Iohexol plasma clearance; Ethnicity