A retrospective assessment of routine renal function screening in patients with sickle cell disease
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BACKGROUND Routine renal screens are essential to the healthcare maintenance of pediatric patients with sickle cell disease. There is an inadequate amount of evidence, however, to support a universal standardized practice. As a result, sickle cell patients are subject to significant variability in care. The objective of this study was to assess the practice of routine renal screens at Boston Children's Hospital. METHODS We performed a chart review of 330 total patients from 2011 through 2013 to analyze the performance of microalbumin renal screens and urinalyses at routine clinic visits. With this data, we evaluated the institution's compliance with its adopted renal screening guidelines, examined renal screening variability across patient demographics and among providers, and compared the performance of different laboratory measures. RESULTS Renal screens were performed in 34.2% of the eligible study population. There were no statistically significant differences in the performance of renal screens across patient age, sickle phenotype or disease-modifying therapy. Patients aged from 5-9 years old, however, demonstrated a non-significant trend toward a lower frequency of successful renal screens. The percentage of samples collected for microalbumin excretion within the female cohort was significantly higher than the institutional average (41.7% vs 34.2%, p = 0.024) and significantly lower within the male population (27.6% vs 34.2%, p = 0.034). The performance of renal screens varied significantly from one provider to another. In all areas of analysis, the frequency of urinalyses performed was similar to the frequency of microalbumin excretion rates. CONCLUSION This study suggests that providers are not routinely adhering to the institutional standard for renal screens. There remains little insight into providers' basis of renal screen practice: providers may not be cognizant of the institution's practice guidelines or may not consider early detection of microalbuminuria essential to the healthcare maintenance in patients with sickle cell disease. Future studies are warranted to fully comprehend the low frequency of renal screens performed in pediatric sickle cell patients.