TY - JOUR
T1 - Renin-angiotensin system blockade promotes a cardio-renal protection in albuminuric homozygous sickle cell patients
AU - Haymann, Jean Philippe
AU - Hammoudi, Nadjib
AU - Stankovic Stojanovic, Katia
AU - Galacteros, Frederic
AU - Habibi, Anoosha
AU - Avellino, Virginie
AU - Bartolucci, Pablo
AU - Benzerara, Yahia
AU - Arlet, Jean Benoit
AU - Djebbar, Morad
AU - Letavernier, Emmanuel
AU - Grateau, Gilles
AU - Tabibzadeh, Nathalie
AU - Girshovich, Alexei
AU - Chaignon, Michel
AU - Girot, Robert
AU - Levy, Pierre
AU - Lionnet, Francois
N1 - Publisher Copyright:
© 2017 John Wiley & Sons Ltd
PY - 2017/12
Y1 - 2017/12
N2 - The management of sickle cell nephropathy (SCN) at an early stage is an important issue to prevent renal and cardiovascular morbidity and mortality. This study aimed to evaluate in this population, whether angiotensin converting enzyme inhibitors (ACEIs) treatment could exert a cardio-renal protection in a SCN cohort. Forty-two SCN patients (urine albumin:creatinine ratio (ACR) > 10 mg/mmol) were treated with ACEIs for 6 months, then evaluated for ACR, measured glomerular filtration rate (mGFR) together with haematological and cardiovascular parameters. A 1-month washout was also performed in order to differentiate short- and long-term ACEIs effects. A decrease in ACR baseline value (>30%) was detected in 62% of cases (mean ACR: 46·4 ± 7·6 and 26·4 ± 3·9 mg/mmol at baseline and 6 months respectively; P = 0·002), whereas mGFR values were unchanged. ACR decrease was detected at 1 month following ACEI initiation (32·9 ± 6·9, P = 0·02) with a persistent trend after withdrawal (P = 0·08). ACEIs also decreased diastolic blood pressure (P = 0·007), pulse wave velocity (P = 0·01), tricuspid regurgitation velocity (TRV; P = 0·04), asymmetric dimethyl arginine (ADMA: P = 0·001) and haemoglobin (P = 0·01) while conventional haemolytic biomarkers were unchanged. Our data suggest that ACEIs are safe and effective at decreasing albuminuria in sickle cell patients with a beneficial effect on specific mortality risk factors, such as TRV and asymmetric dimethyl arginine.
AB - The management of sickle cell nephropathy (SCN) at an early stage is an important issue to prevent renal and cardiovascular morbidity and mortality. This study aimed to evaluate in this population, whether angiotensin converting enzyme inhibitors (ACEIs) treatment could exert a cardio-renal protection in a SCN cohort. Forty-two SCN patients (urine albumin:creatinine ratio (ACR) > 10 mg/mmol) were treated with ACEIs for 6 months, then evaluated for ACR, measured glomerular filtration rate (mGFR) together with haematological and cardiovascular parameters. A 1-month washout was also performed in order to differentiate short- and long-term ACEIs effects. A decrease in ACR baseline value (>30%) was detected in 62% of cases (mean ACR: 46·4 ± 7·6 and 26·4 ± 3·9 mg/mmol at baseline and 6 months respectively; P = 0·002), whereas mGFR values were unchanged. ACR decrease was detected at 1 month following ACEI initiation (32·9 ± 6·9, P = 0·02) with a persistent trend after withdrawal (P = 0·08). ACEIs also decreased diastolic blood pressure (P = 0·007), pulse wave velocity (P = 0·01), tricuspid regurgitation velocity (TRV; P = 0·04), asymmetric dimethyl arginine (ADMA: P = 0·001) and haemoglobin (P = 0·01) while conventional haemolytic biomarkers were unchanged. Our data suggest that ACEIs are safe and effective at decreasing albuminuria in sickle cell patients with a beneficial effect on specific mortality risk factors, such as TRV and asymmetric dimethyl arginine.
KW - albuminuria
KW - asymmetric dimethyl arginine
KW - haemoglobinopathies
KW - haemolysis
KW - sickle cell anaemia
UR - https://www.scopus.com/pages/publications/85031707366
U2 - 10.1111/bjh.14969
DO - 10.1111/bjh.14969
M3 - Article
C2 - 29048108
AN - SCOPUS:85031707366
SN - 0007-1048
VL - 179
SP - 820
EP - 828
JO - British Journal of Haematology
JF - British Journal of Haematology
IS - 5
ER -