Journal article
Management of the Dialysis Patient with Sickle Cell Disease
Seminars in dialysis, v 29(1), pp 62-70
01 Jan 2016
PMID: 26174870
Featured in Collection : UN Sustainable Development Goals @ Drexel
Abstract
While patients with sickle cell disease currently constitute a very small minority of the US dialysis population (0.1%), there is anticipated growth of this group as the life expectancy of those with sickle cell disease (SCD) increases. SCD patients suffer a high burden of morbidity, which is enhanced by the presence of end-stage renal disease (ESRD). In this review, we discuss the pathophysiology of SCD and the basic tenets of its management with focus on the dialysis patient with SCD. Anemia in dialysis patients with SCD is a unique challenge. The hemoglobin target in SCD dialysis patients with ESRD should not exceed 10 g/dl. SCD patients, and particularly those on dialysis, are likely to be poorly responsive to erythropoietin-stimulating agent (ESA) therapy and might be at increased risk for vaso-occlusive crisis (VOC) with ESA. Iron chelation and hydroyxurea therapy require special considerations and modifications in dialysis patients with SCD. There are theoretical advantages to both hemodialysis (HD) and peritoneal dialysis (PD) in SCD patients. With HD, there is a secure vascular access available for both standard and exchange blood transfusion in patients who need them. With PD, the absence of an acute rise in hematocrit with ultrafiltration (UF) might offer lower risk of VOC. During VOC, reduction in UF goals should be considered but administration of intravenous fluids should be reserved only for clear cases of volume depletion. Finally, renal transplantation appears to confer a survival advantage to dialysis in SCD patients and should be pursued when possible.
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Details
- Title
- Management of the Dialysis Patient with Sickle Cell Disease
- Creators
- Suzanne M. Boyle - Drexel UniversityBenjamin Jacobs - Hospital of the University of PennsylvaniaFarzana A. Sayani - Hospital of the University of PennsylvaniaBrenda Hoffman - University of PennsylvaniaBruce T Hoffman - Medicine (Graduate)
- Publication Details
- Seminars in dialysis, v 29(1), pp 62-70
- Publisher
- Wiley
- Number of pages
- 9
- Resource Type
- Journal article
- Language
- English
- Academic Unit
- Medicine (Graduate); College of Medicine
- Web of Science ID
- WOS:000372282400012
- Scopus ID
- 2-s2.0-85000774260
- Other Identifier
- 991019173993804721
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InCites Highlights
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- Collaboration types
- Domestic collaboration
- Web of Science research areas
- Urology & Nephrology