Occult Kidney Dysfunction in Children With Transfusion-Dependent Thalassemia

Background: Thalassemia is the commonest hemoglobinopathy in Southeast Asia. Kidney dysfunction is an underreported sequelae in children with thalassemia. We conducted a retrospective study to identify the prevalence of and predisposing factors for kidney dysfunction in children with transfusion-dep...

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Autores principales:	Nurwahida Mohd Zikre, Nor A. Muhamad, Caroline S. Y. Eng, Nur E. Zailanalhuddin, Charles D. Lai, Jen C. Foo, Suet L. Yap, Hany Ariffin, Karmila Abu Bakar
Formato:	article
Lenguaje:	EN
Publicado:	Frontiers Media S.A. 2021
Materias:	thalassemia nephropathy transfusion-dependent ferritin iron chelator Pediatrics RJ1-570
Acceso en línea:	https://doaj.org/article/a1fd665e01c64201abf4110f25f2a5a8
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spelling	oai:doaj.org-article:a1fd665e01c64201abf4110f25f2a5a82021-11-22T10:48:49ZOccult Kidney Dysfunction in Children With Transfusion-Dependent Thalassemia2296-236010.3389/fped.2021.754813https://doaj.org/article/a1fd665e01c64201abf4110f25f2a5a82021-11-01T00:00:00Zhttps://www.frontiersin.org/articles/10.3389/fped.2021.754813/fullhttps://doaj.org/toc/2296-2360Background: Thalassemia is the commonest hemoglobinopathy in Southeast Asia. Kidney dysfunction is an underreported sequelae in children with thalassemia. We conducted a retrospective study to identify the prevalence of and predisposing factors for kidney dysfunction in children with transfusion-dependent thalassemia (TDT).Method: Abnormal kidney function was defined as children with a glomerular filtration rate (GFR) of <90 ml/min/1.73 m2 or a decline in GFR of >20 ml/min/1.73 m2 or presence of nephrotic range proteinuria within 3 years of commencing regular (every ≤6 weeks) red cell transfusion. Data analyzed were age at diagnosis of thalassemia, number of transfusion-years, iron chelation therapy, serum ferritin, and pre-transfusion hemoglobin levels.Results: Eighty-one children were studied. Mean age was 11.72 ± 5.275 years. Thirty out of 81 (37%) demonstrated abnormal kidney function. Evidence of glomerular hyperfiltration was seen in 29/81 patients (25.85%) at their last clinic visit. This fraction was doubled [48/81 (59.3%)] when the cohort was tracked back by 3 years from the last clinic encounter. Age at diagnosis (RR, 1.157; 95% CI, 1.014–1.319; p = 0.03) and duration of receiving transfusions (RR, 0.984; 95% CI, 0.974–0.994; p = 0.001) were associated with increased risk of developing abnormal kidney function.Conclusion: Abnormal kidney function in children with TDT may be overlooked by medical personnel without active screening measures. Children receiving regular red cell transfusions require systematic surveillance to enable early detection of kidney dysfunction and timely implementation of appropriate therapeutic interventions.Nurwahida Mohd ZikreNor A. MuhamadCaroline S. Y. EngNur E. ZailanalhuddinCharles D. LaiJen C. FooSuet L. YapHany AriffinKarmila Abu BakarFrontiers Media S.A.articlethalassemianephropathytransfusion-dependentferritiniron chelatorPediatricsRJ1-570ENFrontiers in Pediatrics, Vol 9 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	thalassemia nephropathy transfusion-dependent ferritin iron chelator Pediatrics RJ1-570
spellingShingle	thalassemia nephropathy transfusion-dependent ferritin iron chelator Pediatrics RJ1-570 Nurwahida Mohd Zikre Nor A. Muhamad Caroline S. Y. Eng Nur E. Zailanalhuddin Charles D. Lai Jen C. Foo Suet L. Yap Hany Ariffin Karmila Abu Bakar Occult Kidney Dysfunction in Children With Transfusion-Dependent Thalassemia
description	Background: Thalassemia is the commonest hemoglobinopathy in Southeast Asia. Kidney dysfunction is an underreported sequelae in children with thalassemia. We conducted a retrospective study to identify the prevalence of and predisposing factors for kidney dysfunction in children with transfusion-dependent thalassemia (TDT).Method: Abnormal kidney function was defined as children with a glomerular filtration rate (GFR) of <90 ml/min/1.73 m2 or a decline in GFR of >20 ml/min/1.73 m2 or presence of nephrotic range proteinuria within 3 years of commencing regular (every ≤6 weeks) red cell transfusion. Data analyzed were age at diagnosis of thalassemia, number of transfusion-years, iron chelation therapy, serum ferritin, and pre-transfusion hemoglobin levels.Results: Eighty-one children were studied. Mean age was 11.72 ± 5.275 years. Thirty out of 81 (37%) demonstrated abnormal kidney function. Evidence of glomerular hyperfiltration was seen in 29/81 patients (25.85%) at their last clinic visit. This fraction was doubled [48/81 (59.3%)] when the cohort was tracked back by 3 years from the last clinic encounter. Age at diagnosis (RR, 1.157; 95% CI, 1.014–1.319; p = 0.03) and duration of receiving transfusions (RR, 0.984; 95% CI, 0.974–0.994; p = 0.001) were associated with increased risk of developing abnormal kidney function.Conclusion: Abnormal kidney function in children with TDT may be overlooked by medical personnel without active screening measures. Children receiving regular red cell transfusions require systematic surveillance to enable early detection of kidney dysfunction and timely implementation of appropriate therapeutic interventions.
format	article
author	Nurwahida Mohd Zikre Nor A. Muhamad Caroline S. Y. Eng Nur E. Zailanalhuddin Charles D. Lai Jen C. Foo Suet L. Yap Hany Ariffin Karmila Abu Bakar
author_facet	Nurwahida Mohd Zikre Nor A. Muhamad Caroline S. Y. Eng Nur E. Zailanalhuddin Charles D. Lai Jen C. Foo Suet L. Yap Hany Ariffin Karmila Abu Bakar
author_sort	Nurwahida Mohd Zikre
title	Occult Kidney Dysfunction in Children With Transfusion-Dependent Thalassemia
title_short	Occult Kidney Dysfunction in Children With Transfusion-Dependent Thalassemia
title_full	Occult Kidney Dysfunction in Children With Transfusion-Dependent Thalassemia
title_fullStr	Occult Kidney Dysfunction in Children With Transfusion-Dependent Thalassemia
title_full_unstemmed	Occult Kidney Dysfunction in Children With Transfusion-Dependent Thalassemia
title_sort	occult kidney dysfunction in children with transfusion-dependent thalassemia
publisher	Frontiers Media S.A.
publishDate	2021
url	https://doaj.org/article/a1fd665e01c64201abf4110f25f2a5a8
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Occult Kidney Dysfunction in Children With Transfusion-Dependent Thalassemia

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