Renal Function in Infants with Sickle Cell Anemia: Baseline Data from the BABY HUG Trial

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/1.73m²), while Schwartz estimates were higher at 184.4 ± 55.5 mL/min/1.73m². DTPA GFR was correlated with Schwartz GFR (r² = 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.

DTPA, Diethylenetriamenepentaacetic acid, GFR, Glomerular filtration rate, SCA, Sickle cell anemia