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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Frontiers in Pediatrics
2021
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my.unimas.ir.436202023-12-11T02:27:08Z http://ir.unimas.my/id/eprint/43620/ Occult Kidney Dysfunction in Children With Transfusion-Dependent Thalassemia Nurwahida, Mohd Zikre Nor A., Muhamad Caroline S. Y., Eng Nur E., Zailanalhuddin Charles, Lai Dekun Jen C., Foo Suet L., Yap Hany, Ariffin Karmila, Abu Bakar RJ101 Child Health. Child health services 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. Frontiers in Pediatrics 2021-11-22 Article PeerReviewed text en http://ir.unimas.my/id/eprint/43620/3/Occult.pdf Nurwahida, Mohd Zikre and Nor A., Muhamad and Caroline S. Y., Eng and Nur E., Zailanalhuddin and Charles, Lai Dekun and Jen C., Foo and Suet L., Yap and Hany, Ariffin and Karmila, Abu Bakar (2021) Occult Kidney Dysfunction in Children With Transfusion-Dependent Thalassemia. Frontiers in Pediatrics, 9 (9). pp. 1-7. ISSN 2296-2360 https://www.frontiersin.org/articles/10.3389/fped.2021.754813/full#h10 https://doi.org/10.3389/fped.2021.754813 |
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RJ101 Child Health. Child health services Nurwahida, Mohd Zikre Nor A., Muhamad Caroline S. Y., Eng Nur E., Zailanalhuddin Charles, Lai Dekun Jen C., Foo Suet L., Yap Hany, Ariffin Karmila, Abu Bakar Occult Kidney Dysfunction in Children With Transfusion-Dependent Thalassemia |
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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. |
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Nurwahida, Mohd Zikre Nor A., Muhamad Caroline S. Y., Eng Nur E., Zailanalhuddin Charles, Lai Dekun 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, Lai Dekun 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 in Pediatrics |
publishDate |
2021 |
url |
http://ir.unimas.my/id/eprint/43620/3/Occult.pdf http://ir.unimas.my/id/eprint/43620/ https://www.frontiersin.org/articles/10.3389/fped.2021.754813/full#h10 https://doi.org/10.3389/fped.2021.754813 |
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1787140525927694336 |
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13.149126 |