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Management of renal dysfunctions in Escort-HU study
source: American Society of Hematology
authors: Pablo Bartolucci, Gylna Loko, Corinne Charneau, Jean-Antoine Ribeil, Nathalie Lemonne, Stephan Lobitz, Malika Benkerrou, Frederic Galacterossummary/abstract:
BACKGROUND: Renal impairment is a progressive chronic complication of sickle cell disease (SCD) that begins in childhood and may progress until renal failure. It is responsible for mortality in 12% of SS SCD adults (Tehseen S, 2017). Causes of renal damages in SCD patients are multiple: hemolysis, vaso-occlusive episodes which lead to renal injuries, papillary necrosis, medullary fibrosis and focal segmental glomerulosclerosis (Rees D, 2010). Hydroxycarbamide (hydroxyurea or HU) is a myelosuppressive drug marketed since 1968 for the treatment of hematological malignancies, and authorized since 2007 in Europe as an orphan medicinal product for the prevention of recurrent vaso-occlusive crises and acute chest syndrome in adults and children older than 2 years with SCD. HU also seems to protect kidney function in SCD by decreasing proteinuria (Bartolucci P, 2015). As renal excretion is a pathway of HU elimination (60% of dose excreted in urine), consideration should be given to decrease the dose of HU in patients with renal impairment. We propose to study SCD patients with renal diseases treated with hydroxycarbamide (Siklos) and enrolled in ESCORT-HU (European Sickle Cell Disease COhoRT – HydroxyUrea), European multicenter prospective non interventional study.
METHODS: From January 2009 to June 2017, 1841 patients were enrolled in the ESCORT-HU study. 1016 patients were adults and 824 were children (1 date of birth missing). Among them, renal lesions have been reported in the study database in 220 patients (194 adults, 25 children, 1 date of birth missing). At inclusion the renal status of patients are reported in the electronic Case Report Form (e-CRF) using different clinical approaches. It allows to distinguish patients with a medical history of renal impairment (i.e. patient with renal insufficiency of etiology not reported, with an irreversible and progressive reduction in renal function) from patients with a history of sickle cell (SC) nephropathy (patients with any renal alteration related to SCD and not necessarily irreversible and progressive).
CONCLUSION: 12% of SCD patients, mainly adults, enrolled in the ESCORT-HU study had renal dysfunctions at enrolment. As expected this subpopulation is older than the global population of the cohort. Although HU is prescribed at lower doses, these patients go on to have more adverse events and this justifies a close monitoring of them. Controlled trials are required to evaluate the role of HU on the renal failure.organization: Henri Mondor Hospital - APHP, Creteil, France; Martinique University Hospital, Le Lamentin, Martinique; Basse-Terre Hospital, Basse-Terre, Guadeloupe; Necker-Enfants Malades Hospital - APHP, Paris, France; Pointe-à-Pitre Hospital, Pointe-à-Pitre, Guadeloupe; Charité-Universitätsmedizin, Berlin, Germany; Robert Debré Hospital - APHP, Paris, France
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