Renal function in infants with sickle cell anemia: baseline data from the BABY HUG trial

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/1.73m(2)), while Schwartz estimates were higher at 184.4 +/- 55.5 mL/min/1.73m(2). DTPA GFR was correlated with Schwartz GFR (r(2) = 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.

Figure 1

Quantitative GFR analysis by DTPA clearance in the BABY HUG trial. A total of 233 infants were initially screened for eligibility, 40 of whom failed screening. Reasons for inadequate or uninterpretable DTPA results were variable but included poor venous access, extravasated radionuclide, and difficulties with blood collection. A total of 176/191 DTPA attempts (92%) were successful with interpretable results.

Figure 2

Quantitative baseline DTPA GFR correlations in infants with SCA. A, DTPA GFR compared with age, with GFR increasing in older infants, N=176, r²=0.058, p=0.0013. B, DTPA GFR compared with the estimated Schwartz GFR, showing a positive correlation but wide variation, N=157, r²=0.0658, p=0.0012, slope = 0.169.