Regular kidney surveillance may be necessary for timely detection of dysfunction among pediatric patients with transfusion-dependent thalassemia (TDT), according to research published in Frontiers in Pediatrics.
Thalassemia, which is characterized by premature red blood cell rupture and impaired erythropoiesis, is the most common inherited hemoglobinopathy. Among patients who do not receive hematopoietic stem cell transplantation, regular transfusion is essential for reducing symptom burden.
Among pediatric patients with TDT, complications, including infection, allergic reaction, and lung injury, are sometimes seen. There is, however, research indicating that thalassemia may be linked with occult kidney dysfunction, though the effects of specific treatments on this outcome have not previously been investigated in a pediatric TDT population. For this retrospective study, researchers evaluated kidney-related outcomes, as predicted by variety of iron chelation therapy, among a population of pediatric patients with TDT.
Overall, data from 81 patients with TDT were included in this study. In the overall cohort, 51 patients had normal kidney function, while 30 had abnormal kidney function. In the normal and abnormal kidney function groups, the mean ages were 11.83 and 11.54 years, respectively, the ages at diagnosis were 4.31 and 5.62 months, and the durations on transfusion therapy were 89.25 and 65.97 months, respectively (P =.014).
At the last clinical visit, 29 (25.85%) patients had shown evidence of glomerular hyperfiltration; this was true of 59.3% of patients at 3 years after the last clinical encounter.
Both patient age at diagnosis (relative risk, 1.157; P =.03) and duration on transfusion therapy (relative risk, 0.984; P =.001) were linked with risk of abnormal kidney function in the overall cohort.
“Normal creatinine, growth, and blood pressure do not exclude the existence of kidney dysfunction in this group of patients,” the authors wrote. “Careful interpretation of day-to-day clinical assessment will help clinicians to detect patients at risk.”
Mohd Zikre N, Muhamad NA, Eng CSY, et al. Occult kidney dysfunction in children with transfusion-dependent thalassemia. Front Pediatr. 2021;9:754813. doi:10.3389/fped.2021.754813