Trends in the Renal Manifestations of Sickle Cell Disease over the Last 10 Years: A Nationwide Analysis

Background: The rising number of adults with sickle cell disease (SCD) has underscored a notable increase in end-organ dysfunction like sickle cell hepatopathy, nephropathy and cardiomyopathy. No report to date has examined the trends in the renal manifestations of SCD Aim: To determine the morbidity and mortality associated with renal dysfunction in patients with and without SCD across a decade using national database Methods: We included all admissions with renal conditions to acute care hospitals across the United States from 2012 to 2021. Confounders were accounted for using multivariable regression analyses Results: Inpatient hospitalizations due to renal issues steadily increased from 1543031 to 2313787 from 2012 to 2021, among them 4070 had SCD in 2012 while 8529 had SCD in 2021. Incidence of renal issues in SCD reduced from 5217 per 100,000 to 4802 per 100,000 during this period. In-hospital mortality rates from renal issues increased from 3.6% to 4.9%[adjusted odds ratio- 1.06; CI 1.0-1.13; trend p 0.04] in those patients with SCD while it increased from 4.4% to 6.2%[adjusted odds ratio-1.05; CI 1.05-1.06; trend p 0.000] in those without SCD from 2012 to 2021. Renal transplantation rate was 1.47% and 1.09% for patients with and without SCD in 2012, that increased to 1.64% for patients with SCD while it decreased to 1.06% for patients without SCD in 2021. ESRD and dialysis rates reduced significantly from 56% to 39% in patients without SCD while in patients with SCD a higher rate of ESRD and dialysis with only a minor reduction in rates from 68% to 64% was noted from 2012 to 2021. Mean length of hospitalization was higher and showed an increasing trend from 2012 to 2021 for patients with [7.1 to 7.5d]and without SCD[6.4 to 7d] with a trend p value of 0.000. A similar increase in hospitalization charges from $75219 to $98152 in SCD vs $71369 to $96534 in those without SCD[trend p 0.000] was noted during the same period. Conclusion: Though there is slight reduction in incidence of renal issues in SCD over the last decade, in-hospital mortality significantly increased. SCD patients with renal issues had higher rates of ESRD, dialysis and transplantation compared to non-SCD patients with renal issues. A higher morbidity rates in terms of hospitalization charges and duration was also noted