208 results on '"Santosh L. Saraf"'
Search Results
2. Gene expression changes in sickle cell reticulocytes and their clinical associations
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Xu Zhang, Jihyun Song, Binal N. Shah, Jin Han, Taif Hassan, Galina Miasniakova, Adelina Sergueeva, Sergei Nekhai, Roberto F. Machado, Mark T. Gladwin, Santosh L. Saraf, Josef T. Prchal, and Victor R. Gordeuk
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Medicine ,Science - Abstract
Abstract Transcriptional changes in compensatory erythropoiesis in sickle cell anemia (SCA) and their disease modulation are unclear. We detected 1226 differentially expressed genes in hemoglobin SS reticulocytes compared to non-anemic hemoglobin AA controls. Assessing developmental expression changes in hemoglobin AA erythroblasts for these genes suggests heightened terminal differentiation in early erythroblasts in SCA that diminishes toward the polychromatic to orthochromatic stage transition. Comparison of reticulocyte gene expression changes in SCA with that in Chuvash erythrocytosis, a non-anemic disorder of increased erythropoiesis due to constitutive activation of hypoxia inducible factors, identified 453 SCA-specific changes attributable to compensatory erythropoiesis. Peripheral blood mononuclear cells (PBMCs) in SCA contain elevated proportions of erythroid progenitors due to heightened erythropoiesis. Deconvolution analysis in PBMCs from 131 SCA patients detected 54 genes whose erythroid expression correlated with erythropoiesis efficiency, which were enriched with SCA-specific changes (OR = 2.9, P = 0.00063) and annotation keyword “ubiquitin-dependent protein catabolic process”, “protein ubiquitination”, and “protein polyubiquitination” (OR = 4.2, P = 7.5 × 10–5). An erythroid expression quantitative trait locus of one of these genes, LNX2 encoding an E3 ubiquitin ligase, associated with severe pain episodes in 774 SCA patients (OR = 1.7, P = 3.9 × 10–5). Thus, erythroid gene transcription responds to unique conditions within SCA erythroblasts and these changes potentially correspond to vaso-occlusive manifestations.
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- 2023
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3. Community‐level socioeconomic distress is associated with nutritional status in adults with sickle cell anemia
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Syeda Akila Ally, Jin Han, Ryan Sun, Robert E. Molokie, Victor R. Gordeuk, James P. Lash, and Santosh L. Saraf
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distressed community index ,nutrition ,sickle cell anemia ,socioeconomic ,Diseases of the blood and blood-forming organs ,RC633-647.5 - Abstract
Abstract Sickle cell anemia (SCA) negatively impacts the ability to achieve educational and occupational goals increasing vulnerability to socioeconomic challenges. In a cross‐sectional analysis of 332 SCA adults, we investigated whether the distressed community index (DCI) was associated with SCA‐related complications and nutritional status. More patients with higher DCI had Medicaid insurance. A higher DCI was independently associated with tobacco use and lower body mass index, serum albumin, and vitamin D 25‐OH levels after adjusting for insurance status but was not associated with SCA‐related complications. Future studies investigating access to healthy foods may help improve health equity in patients with SCA.
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- 2023
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4. Predictors and clinical complications associated with antiphospholipid antibodies in sickle cell disease
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Claudia Rodriguez Rivera, Andrew Srisuwananukorn, Rizma Jalees Bajwa, Victor R. Gordeuk, Joyce Rauch, Jerrold S. Levine, and Santosh L. Saraf
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antiphospholipid antibody ,antiphospholipid syndrome ,multiorgan failure ,sickle cell disease ,systemic lupus erythematosus ,Diseases of the blood and blood-forming organs ,RC633-647.5 - Abstract
Abstract Although a higher prevalence of antiphospholipid autoantibodies (aPL) has been observed in some cohorts of sickle cell disease (SCD) patients, the clinical risk factors for the development of aPL and its associated complications remain unclear. In a retrospective study of 63 SCD patients, a lower hemoglobin concentration and higher white blood cell count were independently associated with an elevated aPL. SCD patients with elevated aPL had increased pregnancy complications (≥3 miscarriages, preterm delivery, pre‐eclampsia) and venous thrombotic events. Our findings suggest that SCD may predispose to the generation of aPL and that aPL itself may contribute to the vasculopathy of SCD. Prospective testing for aPL is warranted in patients with SCD.
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- 2023
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5. Treatment patterns and burden of complications associated with sickle cell disease: A US retrospective claims analysis
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Deepa Manwani, Arthur L. Burnett, Jincy Paulose, Glorian P. Yen, Tanya Burton, Amy Anderson, Sara Wang, Soyon Lee, and Santosh L. Saraf
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healthcare costs ,opioid use ,organ dysfunction ,retrospective studies ,sickle cell disease ,United States ,Diseases of the blood and blood-forming organs ,RC633-647.5 - Abstract
Abstract Complications associated with sickle cell disease (SCD) that are highly impactful for patients but until recently have been less understood include priapism, nephropathy, and neurologic injury. We conducted a retrospective study using US administrative claims data from July 01, 2013 through March 31, 2020 to analyze incidence of these complications, SCD treatment patterns, and healthcare resource utilization (HCRU) and costs among 2524 pediatric and adult patients with SCD (mean [SD] age 43.4 [22.4] years). The most common treatments during follow‐up were short‐acting opioids (54.0% of patients), red blood cell transfusion (15.9%), and hydroxyurea (11.0%). SCD complications occurred frequently; in the overall population, the highest follow‐up incidences per 1000 person‐years were for acute kidney injury (53.1), chronic kidney disease (40.6), and stroke (39.0). Complications occurred across all age groups but increased in frequency with age; notably, acute kidney injury was 69.7 times more frequent among ages 65+ than ages 0–15 (p
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- 2022
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6. Publisher Correction: Gene expression changes in sickle cell reticulocytes and their clinical associations
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Xu Zhang, Jihyun Song, Binal N. Shah, Jin Han, Taif Hassan, Galina Miasniakova, Adelina Sergueeva, Sergei Nekhai, Roberto F. Machado, Mark T. Gladwin, Santosh L. Saraf, Josef T. Prchal, and Victor R. Gordeuk
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Medicine ,Science - Published
- 2023
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7. Sex differences in progression of kidney disease in sickle cell disease
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Kenneth I. Ataga, Qingning Zhou, Santosh L. Saraf, Jane S. Hankins, Emily J. Ciccone, Laura R. Loehr, Melanie E. Garrett, Allison E. Ashley-Koch, Jianwen Cai, Marilyn J. Telen, and Vimal K. Derebail
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Diseases of the blood and blood-forming organs ,RC633-647.5 - Published
- 2022
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8. Using machine learning to predict rapid decline of kidney function in sickle cell anemia
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Fatma Güntürkün, Daiqing Chen, Oguz Akbilgic, Robert L. Davis, Ibrahim Karabayir, Maxwell Strome, Yang Dai, Santosh L. Saraf, and Kenneth I. Ataga
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chronic kidney disease ,machine learning models ,predictive capacity ,rapid decline of eGFR ,sickle cell disease ,Diseases of the blood and blood-forming organs ,RC633-647.5 - Published
- 2021
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9. Evaluation of point‐of‐care International Normalized Ratio in sickle cell disease
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Syeda Rahman, Andrew Srisuwananukorn, Robert E. Molokie, Michel Gowhari, Franklin Njoku, Faiz Ahmed Hussain, James Lee, Edith A. Nutescu, Victor R. Gordeuk, Santosh L. Saraf, and Jin Han
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Diseases of the blood and blood-forming organs ,RC633-647.5 - Abstract
Abstract Background Point‐of‐care (POC) International Normalized Ratio (INR) measurement provides efficient monitoring of warfarin therapy; however, its reliability may be affected in patients with anemia, such as those with sickle cell disease (SCD). Objectives To evaluate the correlation of POC‐INR to clinical laboratory INR (CL‐INR) in SCD and use of a correction factor. Patient/Methods In this retrospective study, the accuracy of POC‐INR compared to CL‐INR was evaluated in a cohort of patients with SCD and in a non‐SCD Black cohort. Results Despite the difference in anemia, the SCD cohort showed a similar percentage of in‐range POC‐INR values as observed in the non‐SCD cohort (37% vs 42%). The SCD cohort was randomly divided to form discovery and validation cohorts. In the discovery cohort, 86% of POC‐INRs were in range when the POC‐INRs were ˂4.0, but only 24% were in range if POC‐INRs were ≥4.0. A linear regression of CL‐INR versus POC‐INR for POC‐INR values ≥4.0 yielded a coefficient of 0.72 (95% confidence interval, 0.69‐0.75); Multiplying POC‐INR by this correction factor, rounded to 0.7 for ease of use in clinical practice, improved the proportion of in‐range POC‐INR values ≥4.0 from 24% to 100% in the SCD discovery cohort and from 19% to 95% in the SCD validation cohort. Similar findings applied to analyses of the non‐SCD cohort. Conclusions POC‐INR and CL‐INR in patients with SCD are similar when POC‐INR is
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- 2021
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10. Effects of renin‐angiotensin blockade and APOL1 on kidney function in sickle cell disease
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Jin Han, Andrew Srisuwananukorn, Binal N. Shah, Robert E. Molokie, James P. Lash, Victor R. Gordeuk, and Santosh L. Saraf
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angiotensin converting enzyme inhibitors ,angiotensin receptor blockers ,APOL1 ,sickle cell disease ,Diseases of the blood and blood-forming organs ,RC633-647.5 - Published
- 2021
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11. Rapid decline in estimated glomerular filtration rate in sickle cell anemia: results of a multicenter pooled analysis
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Kenneth I. Ataga, Qingning Zhou, Vimal K. Derebail, Santosh L. Saraf, Jane S. Hankins, Laura R. Loehr, Melanie E. Garrett, Allison E. Ashley-Koch, Jianwen Cai, and Marilyn J. Telen
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Diseases of the blood and blood-forming organs ,RC633-647.5 - Published
- 2020
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12. Antimicrobial resistance is a risk factor for mortality in adults with sickle cell disease
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Andrew Srisuwananukorn, Jin Han, Rasha Raslan, Michel Gowhari, Faiz Hussain, Franklin Njoku, Robert E Molokie, Victor R. Gordeuk, and Santosh L. Saraf
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Diseases of the blood and blood-forming organs ,RC633-647.5 - Published
- 2020
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13. Associations of α-thalassemia and BCL11A with stroke in Nigerian, United States, and United Kingdom sickle cell anemia cohorts
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Santosh L. Saraf, Titilola S. Akingbola, Binal N. Shah, Chinedu A. Ezekekwu, Omowunmi Sonubi, Xu Zhang, Lewis L. Hsu, Mark T. Gladwin, Roberto F. Machado, Richard S. Cooper, Victor R. Gordeuk, and Bamidele O. Tayo
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Specialties of internal medicine ,RC581-951 - Abstract
Abstract: α-Thalassemia and the BCL11A rs1427407 T allele are commonly observed in sickle cell anemia (SCA) patients and are associated with reduced hemolysis and higher hemoglobin F levels, respectively. We investigated whether a high-risk genetic profile, defined as SCA patients who did not inherit either α-thalassemia or the BCL11A rs1427407 T allele, had stronger associations with clinical and laboratory variables than the individual genetic components in the University of Ibadan cohort (N = 249). We then replicated our findings in SCA cohorts from the University of Illinois at Chicago (UIC) (N = 260) and the Walk-Treatment of Pulmonary Hypertension and Sickle Cell Disease with Sildenafil Therapy study (Walk-PHaSST) (N = 387). A high-risk genetic profile was associated with higher reticulocytes (15.0% vs 7.8%, P = .08) and stroke history (6% vs 1%, P = .02) than standard-risk patients, and these associations were more significant than the individual genetic components in the University of Ibadan cohort. These findings were replicated in high-risk patients from UIC and Walk-PHaSST for reticulocytes (UIC: 13.5% vs 11.8%, P = .03; Walk-PHaSST: 9.6% vs 8.2%, P = .0003) and stroke history (UIC: 32% vs 22%, P = .07; Walk-PHaSST: 14% vs 7%, P = .01). On combined analysis, a high-risk genetic profile had strong associations with increased markers of hemolysis (hemoglobin β = –0.29, 95% confidence interval [CI]: −0.50 to −0.09; P=.006; reticulocyte% β = 2.29, 95% CI: 1.31-3.25; P = 1 × 10−5) and stroke history (odds ratio = 2.0, 95% CI: 1.3-3.0; P = .0002), but no association with frequent vaso-occlusive crises (≥3 per year). A high-risk genetic profile is associated with increased hemolysis and stroke history in 3 independent cohorts. This profile may help identify patients to prioritize for hydroxyurea and for closer monitoring strategies for stroke.
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- 2017
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14. Increased vancomycin dosing requirements in sickle cell disease due to hyperfiltration-dependent and independent pathways
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Jin Han, Xu Zhang, Jennifer Oderinde, Santosh L. Saraf, Michel Gowhari, Joharah Hassan, Shivi Jain, Victor R. Gordeuk, and Robert E. Molokie
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Diseases of the blood and blood-forming organs ,RC633-647.5 - Published
- 2017
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15. APOL1, α-thalassemia, and BCL11A variants as a genetic risk profile for progression of chronic kidney disease in sickle cell anemia
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Santosh L. Saraf, Binal N. Shah, Xu Zhang, Jin Han, Bamidele O. Tayo, Taimur Abbasi, Adam Ostrower, Elizabeth Guzman, Robert E. Molokie, Michel Gowhari, Johara Hassan, Shivi Jain, Richard S. Cooper, Roberto F. Machado, James P. Lash, and Victor R. Gordeuk
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Diseases of the blood and blood-forming organs ,RC633-647.5 - Published
- 2017
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16. Genetic variants and cell-free hemoglobin processing in sickle cell nephropathy
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Santosh L. Saraf, Xu Zhang, Binal Shah, Tamir Kanias, Krishnamurthy P. Gudehithlu, Rick Kittles, Roberto F. Machado, Jose A.L. Arruda, Mark T. Gladwin, Ashok K. Singh, and Victor R. Gordeuk
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Diseases of the blood and blood-forming organs ,RC633-647.5 - Abstract
Intravascular hemolysis and hemoglobinuria are associated with sickle cell nephropathy. ApoL1 is involved in cell-free hemoglobin scavenging through association with haptoglobin-related protein. APOL1 G1/G2 variants are the strongest genetic predictors of kidney disease in the general African-American population. A single report associated APOL1 G1/G2 with sickle cell nephropathy. In 221 patients with sickle cell disease at the University of Illinois at Chicago, we replicated the finding of an association of APOL1 G1/G2 with proteinuria, specifically with urine albumin concentration (β=1.1, P=0.003), observed an even stronger association with hemoglobinuria (OR=2.5, P=4.3×10−6), and also replicated the finding of an association with hemoglobinuria in 487 patients from the Walk-Treatment of Pulmonary Hypertension and Sickle cell Disease with Sildenafil Therapy study (OR=2.6, P=0.003). In 25 University of Illinois sickle cell disease patients, concentrations of urine kidney injury molecule-1 correlated with urine cell-free hemoglobin concentrations (r=0.59, P=0.002). Exposing human proximal tubular cells to increasing cell-free hemoglobin led to increasing concentrations of supernatant kidney injury molecule-1 (P=0.01), reduced viability (P=0.01) and induction of HMOX1 and SOD2. HMOX1 rs743811 associated with chronic kidney disease stage (OR=3.0, P=0.0001) in the University of Illinois cohort and end-stage renal disease (OR=10.0, P=0.0003) in the Walk-Treatment of Pulmonary Hypertension and Sickle cell Disease with Sildenafil Therapy cohort. Longer HMOX1 GT-tandem repeats (>25) were associated with lower estimated glomerular filtration rate in the University of Illinois cohort (P=0.01). Our findings point to an association of APOL1 G1/G2 with kidney disease in sickle cell disease, possibly through increased risk of hemoglobinuria, and associations of HMOX1 variants with kidney disease, possibly through reduced protection of the kidney from hemoglobin-mediated toxicity.
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- 2015
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17. Haptoglobin 1 allele predicts higher serum haptoglobin concentration and lower multiorgan failure risk in sickle cell disease
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Maria A. Ruiz, Binal N. Shah, Guohui Ren, Faiz Hussain, Franklin Njoku, Roberto F. Machado, Victor R. Gordeuk, and Santosh L. Saraf
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Hemoglobins ,Haptoglobins ,Multiple Organ Failure ,Acute Chest Syndrome ,Humans ,Anemia, Sickle Cell ,Hematology ,Alleles - Abstract
Haptoglobin (HP) is an acute-phase protein and the main scavenger of cell-free hemoglobin. When HP is depleted, as observed in hemolytic conditions such as sickle cell disease (SCD), cell-free hemoglobin can lead to acute organ damage. The impact of the HP 1-1, 2-1, and 2-2 isoforms on HP and cell-free hemoglobin concentrations and SCD-related complications is unclear. In a longitudinal cohort of patients with SCD, the HP 1 allele was associated with higher HP and lower cell-free hemoglobin concentrations at a routine clinic visit as well as during hospitalization for a vaso-occlusive episode or acute chest syndrome. With a median follow-up of 6.8 years, acute chest syndrome occurred in 42% (n = 163) and multiorgan failure in 14% (n = 53) of 391 patients with SCD with a minimum follow-up of 6 months. The HP 1 allele was independently associated with lower risk of developing multiorgan failure during acute chest syndrome (additive model hazard ratio, 0.5; P < .001). Future studies assessing the regulation of HP concentrations and ability to bind cell-free hemoglobin according to the HP genotype may help to identify patients with SCD at high risk for multiorgan failure and to guide interventions, such as rapid initiation of exchange transfusion or HP replacement therapy.
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- 2022
18. Longitudinal study of glomerular hyperfiltration in adults with sickle cell anemia: a multicenter pooled analysis
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Kenneth I. Ataga, Qingning Zhou, Santosh L. Saraf, Jane S. Hankins, Emily J. Ciccone, Laura R. Loehr, Allison E. Ashley-Koch, Melanie E. Garrett, Jianwen Cai, Marilyn J. Telen, and Vimal K. Derebail
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Adult ,Male ,Young Adult ,Humans ,Hydroxyurea ,Female ,Anemia, Sickle Cell ,Longitudinal Studies ,Hematology ,Renal Insufficiency, Chronic ,Glomerular Filtration Rate - Abstract
Glomerular hyperfiltration is common in young sickle cell anemia patients and precedes development of overt kidney disease. In this multicenter pooled cohort, we characterized hyperfiltration and its decline to normal range in adult patients. Glomerular filtration rate (GFR) was estimated using the creatinine-based 2009 CKD-EPI (Chronic Kidney Disease Epidemiology Collaboration) equation omitting race adjustment and the 2021 CKD-EPI equation. Using CKD-EPI–2009, 506 patients had baseline estimated GFR (eGFR) ≥90 mL/min per 1.73 m2, median age of 24 (interquartile range [IQR], 19-34) years and 5.17 years of follow-up. The prevalence of hyperfiltration (eGFR ≥140 and ≥130 mL/min per 1.73 m2 for men and women, respectively) was 38.3%. Using CKD-EPI–2009, baseline hyperfiltration was less likely with older age (odds ratio [OR], 0.78; 95% confidence interval [CI], 0.73-0.83; P < .0001), male sex (OR, 0.32; 95% CI, 0.18-0.58; P = .0002), and higher weight (OR, 0.96; 95% CI, 0.94-0.99; P = .001). Using CKD-EPI–2021, hyperfiltration was similarly less likely with older age (OR, 0.75; 95% CI, 0.70-0.81; P < .0001), male sex (OR, 0.24; 95% CI, 0.13-0.44; P < .0001), and higher weight (OR, 0.97; 95% CI, 0.95-0.99; P = .004). In patients with baseline hyperfiltration, eGFR declined to normal values at a median age of 26.2 years. Using CKD-EPI–2009, this decline was associated with male sex (HR, 2.20; 95% CI, 1.26-3.87; P = .006), systolic blood pressure (hazard ratio [HR], 1.02; 95% CI, 1.01-1.04; P = .01), and hydroxyurea use (HR, 1.74; 95% CI, 1.002-3.03; P = .05). Using CKD-EPI–2021, decline of eGFR to normal was only associated with male sex (HR, 3.39; 95% CI, 2.01-5.69; P < .0001). Decline to normal eGFR range from hyperfiltration occurs earlier in males, those on hydroxyurea, and with higher systolic blood pressure.
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- 2022
19. Proteomic cardiovascular risk assessment in chronic kidney disease
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Rajat Deo, Ruth F Dubin, Yue Ren, Ashwin C Murthy, Jianqiao Wang, Haotian Zheng, Zihe Zheng, Harold Feldman, Haochang Shou, Josef Coresh, Morgan Grams, Aditya L Surapaneni, Zeenat Bhat, Jordana B Cohen, Mahboob Rahman, Jiang He, Santosh L Saraf, Alan S Go, Paul L Kimmel, Ramachandran S Vasan, Mark R Segal, Hongzhe Li, and Peter Ganz
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Cardiology and Cardiovascular Medicine - Abstract
Aims Chronic kidney disease (CKD) is widely prevalent and independently increases cardiovascular risk. Cardiovascular risk prediction tools derived in the general population perform poorly in CKD. Through large-scale proteomics discovery, this study aimed to create more accurate cardiovascular risk models. Methods and results Elastic net regression was used to derive a proteomic risk model for incident cardiovascular risk in 2182 participants from the Chronic Renal Insufficiency Cohort. The model was then validated in 485 participants from the Atherosclerosis Risk in Communities cohort. All participants had CKD and no history of cardiovascular disease at study baseline when ∼5000 proteins were measured. The proteomic risk model, which consisted of 32 proteins, was superior to both the 2013 ACC/AHA Pooled Cohort Equation and a modified Pooled Cohort Equation that included estimated glomerular filtrate rate. The Chronic Renal Insufficiency Cohort internal validation set demonstrated annualized receiver operating characteristic area under the curve values from 1 to 10 years ranging between 0.84 and 0.89 for the protein and 0.70 and 0.73 for the clinical models. Similar findings were observed in the Atherosclerosis Risk in Communities validation cohort. For nearly half of the individual proteins independently associated with cardiovascular risk, Mendelian randomization suggested a causal link to cardiovascular events or risk factors. Pathway analyses revealed enrichment of proteins involved in immunologic function, vascular and neuronal development, and hepatic fibrosis. Conclusion In two sizeable populations with CKD, a proteomic risk model for incident cardiovascular disease surpassed clinical risk models recommended in clinical practice, even after including estimated glomerular filtration rate. New biological insights may prioritize the development of therapeutic strategies for cardiovascular risk reduction in the CKD population.
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- 2023
20. Trans-ethnic genome-wide association study of blood metabolites in the Chronic Renal Insufficiency Cohort (CRIC) study
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Eugene P. Rhee, Aditya Surapaneni, Zihe Zheng, Linda Zhou, Diptavo Dutta, Dan E. Arking, Jingning Zhang, ThuyVy Duong, Nilanjan Chatterjee, Shengyuan Luo, Pascal Schlosser, Rupal Mehta, Sushrut S. Waikar, Santosh L. Saraf, Tanika N. Kelly, Lee L. Hamm, Panduranga S. Rao, Anna V. Mathew, Chi-yuan Hsu, Afshin Parsa, Ramachandran S. Vasan, Paul L. Kimmel, Clary B. Clish, Josef Coresh, Harold I. Feldman, and Morgan E. Grams
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Cohort Studies ,Male ,Nephrology ,Ethnicity ,Humans ,Female ,Renal Insufficiency, Chronic ,Polymorphism, Single Nucleotide ,Article ,Linkage Disequilibrium ,Genome-Wide Association Study - Abstract
Metabolomics genome wide association study (GWAS) help outline the genetic contribution to human metabolism. However, studies to date have focused on relatively healthy, population-based samples of White individuals. Here, we conducted a GWAS of 537 blood metabolites measured in the Chronic Renal Insufficiency Cohort (CRIC) Study, with separate analyses in 822 White and 687 Black study participants. Trans-ethnic meta-analysis was then applied to improve fine-mapping of potential causal variants. Mean estimated glomerular filtration rate was 44.4 and 41.5 mL/min/1.73m(2) in the White and Black participants, respectively. There were 45 significant metabolite associations at 19 loci, including novel associations at PYROXD2, PHYHD1, FADS1-3, ACOT2, MYRF, FAAH, and LIPC. The strength of associations were unchanged in models additionally adjusted for estimated glomerular filtration rate and proteinuria, consistent with a direct biochemical effect of gene products on associated metabolites. At several loci, trans-ethnic meta-analysis, which leverages differences in linkage disequilibrium across populations, reduced the number and/or genomic interval spanned by potentially causal single nucleotide polymorphisms compared to fine-mapping in the White participant cohort alone. Across all validated associations, we found strong concordance in effect sizes of the potentially causal single nucleotide polymorphisms between White and Black study participants. Thus, our study identifies novel genetic determinants of blood metabolites in chronic kidney disease, demonstrates the value of diverse cohorts to improve causal inference in metabolomics GWAS, and underscores the shared genetic basis of metabolism across race.
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- 2022
21. Use of Multiple Urinary Biomarkers for the Early Detection of Chronic Kidney Disease in Sickle Cell Anemia
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Yagahira Castro Sesquen, Santosh L Saraf, Victor R Gordeuk, Sergei Nekhai, and Marina Jerebtsova
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Hematology - Published
- 2023
22. Iron status, fibroblast growth factor 23 and cardiovascular and kidney outcomes in chronic kidney disease
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Lawrence J. Appel, Harold I. Feldman, Rupal Mehta, Santosh L. Saraf, Jiang He, Mahboob Rahman, Jing Chen, Monique E. Cho, Xuan Cai, Tamara Isakova, Robert G. Nelson, Panduranga S. Rao, Jongmin Lee, Mark Unruh, Vallabh O. Shah, John M. Flack, Alan S. Go, Valentin David, Tariq Shafi, Myles Wolf, James P. Lash, and Raymond R. Townsend
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Fibroblast growth factor 23 ,medicine.medical_specialty ,Iron ,Kidney ,Gastroenterology ,Article ,Cohort Studies ,Internal medicine ,medicine ,Humans ,Renal Insufficiency, Chronic ,biology ,Transferrin saturation ,business.industry ,Iron deficiency ,medicine.disease ,Ferritin ,Fibroblast Growth Factor-23 ,medicine.anatomical_structure ,Nephrology ,Heart failure ,biology.protein ,Hemoglobin ,business ,Kidney disease - Abstract
Disordered iron and mineral homeostasis are interrelated complications of chronic kidney disease that may influence cardiovascular and kidney outcomes. In a prospective analysis of 3747 participants in the Chronic Renal Insufficiency Cohort Study, we investigated risks of mortality, heart failure, end-stage kidney disease (ESKD), and atherosclerotic cardiovascular disease according to iron status, and tested for mediation by C-terminal fibroblast growth factor 23 (FGF23), hemoglobin and parathyroid hormone. Study participants were agnostically categorized based on quartiles of transferrin saturation and ferritin as: “Iron Replete” (27.1% of participants; referent group for all outcomes analyses), “Iron Deficiency” (11.1%), “Functional Iron Deficiency” (7.6%), “Mixed Iron Deficiency” (iron indices between the Iron Deficiency and Functional Iron Deficiency groups; 6.3%), “High Iron” (9.2%), or “Non-Classified” (the remaining 38.8% of participants). In multivariable-adjusted Cox models, Iron Deficiency independently associated with mortality (hazard ratio 1.28, 95% confidence interval 1.04–1.58) and heart failure (1.34, 1.05–1.72). Mixed Iron Deficiency associated with mortality (1.61, 1.27–2.04) and ESKD (1.33, 1.02–1.73). High Iron associated with mortality (1.54, 1.24–1.91), heart failure (1.58, 1.21–2.05), and ESKD (1.41, 1.13–1.77). Functional Iron Deficiency did not significantly associate with any outcome, and no iron group significantly associated with atherosclerotic cardiovascular disease. Among the candidate facilitators, FGF23 most significantly mediated the risks of mortality and heart failure conferred by Iron Deficiency. Thus, alterations in iron homeostasis associated with adverse cardiovascular and kidney outcomes in patients with chronic kidney disease.
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- 2021
23. G-CSF Improves Stable Engraftment in Adults with Sickle Cell Disease Undergoing Nonmyeloablative Hematopoietic Stem Cell Transplantation
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Lucas Maahs, Karen Sweiss, Pritesh Patel, Sally Campbell-Lee, Nadim Mahmud, Victor R. Gordeuk, Damiano Rondelli, and Santosh L. Saraf
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Immunology ,Cell Biology ,Hematology ,Biochemistry - Published
- 2022
24. Diabetes, Diabetic Control, and Kidney Dysfunction in Adults with Sickle Cell Disease
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Ryan Sun, Jin Han, James P. Lash, Victor R. Gordeuk, and Santosh L. Saraf
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Immunology ,Cell Biology ,Hematology ,Biochemistry - Published
- 2022
25. Pre-Transplant Assessment of Adult Sickle Cell Patients Shows a High Prevalence of Psychosocial Frailties before Allogeneic Stem Cell Transplant
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Karen Sweiss, Santosh L. Saraf, Alison Doane, Monika Mandava, Ryan Sun, Mahir Khan, Zacharie Paul Charles Hamilton, Jaleel G. Sweis, Victor R. Gordeuk, Damiano Rondelli, Lisa Sharp, and Pritesh Patel
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Immunology ,Cell Biology ,Hematology ,Biochemistry - Published
- 2022
26. Safety and Efficacy of the Addition of the Protein Translation Inhibitor Omacetaxine to Induction with Cytarabine and Idarubicin in Newly Diagnosed AML
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Samin Houshyar, Betul Gok Yavuz, Pritesh Patel, Nadim Mahmud, Karen Sweiss, Irum Khan, Santosh L. Saraf, Damiano Rondelli, Anwar Khan, and John G. Quigley
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Immunology ,Cell Biology ,Hematology ,Biochemistry - Published
- 2022
27. Updated Analyses: Safety and Efficacy of Gemtuzumab Ozogamicin and Venetoclax in Patients with Relapsed or Refractory CD33+ Acute Myeloid Leukemia: A Phase Ib/II Study
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Saad Arain, Ana Maria Avila, Sonia Christian, Pritesh Patel, Karen Sweiss, Brian Parkin, Santosh L. Saraf, Paul G. Rubinstein, Gregory S Calip, and John G. Quigley
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Immunology ,Cell Biology ,Hematology ,Biochemistry - Published
- 2022
28. Using machine learning to predict rapid decline of kidney function in sickle cell anemia
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Kenneth I. Ataga, Oguz Akbilgic, Robert L. Davis, Yang Dai, Daiqing Chen, Ibrahim Karabayir, Maxwell Strome, Fatma Güntürkün, and Santosh L. Saraf
- Subjects
business.industry ,Medicine ,Renal function ,Bioinformatics ,business ,medicine.disease ,Sickle cell anemia - Published
- 2021
29. Non‐myeloablative human leukocyte antigen‐matched related donor transplantation in sickle cell disease: outcomes from three independent centres
- Author
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Damiano Rondelli, Moussab Damlaj, Matthew M. Hsieh, Avani Singh, Bader Alahmari, Mohsen Alzahrani, Neal Jeffries, John F. Tisdale, and Santosh L. Saraf
- Subjects
Adult ,Graft Rejection ,Male ,medicine.medical_specialty ,Myeloid ,Adolescent ,Platelet Engraftment ,medicine.medical_treatment ,Graft vs Host Disease ,Anemia, Sickle Cell ,Gastroenterology ,Pulmonary function testing ,Young Adult ,03 medical and health sciences ,Antineoplastic Agents, Immunological ,0302 clinical medicine ,HLA Antigens ,Internal medicine ,Humans ,Transplantation, Homologous ,Medicine ,Child ,Alemtuzumab ,Sirolimus ,business.industry ,Graft Survival ,Hematopoietic Stem Cell Transplantation ,Immunosuppression ,Hematology ,Middle Aged ,Total body irradiation ,Tissue Donors ,Transplantation ,Regimen ,Treatment Outcome ,medicine.anatomical_structure ,030220 oncology & carcinogenesis ,Female ,business ,Immunosuppressive Agents ,030215 immunology ,medicine.drug - Abstract
Non-myeloablative haematopoietic progenitor cell transplantation (HPCT) from matched related donors (MRD) has been increasingly utilized in sickle cell disease (SCD). A total of 122 patients received 300 cGy of total body irradiation (TBI), alemtuzumab, unmanipulated filgrastim-mobilized peripheral blood HPC and sirolimus. The median follow-up was four years; median age at HPCT was 29 years. Median neutrophil and platelet engraftment occurred on day 22 and 19 respectively; 41 patients required no platelet transfusions. Overall and sickle-free survival at one and five years were 93% and 85% respectively. Age, sex, pre-HPCT sickle complications, ferritin and infused HPC numbers were similar between graft failure and engrafted patients. Mean donor myeloid chimaerism at one and five years post HPCT were 84% and 88%, and CD3 was 48% and 53% respectively. Two patients developed grade 1 and 2 skin graft-versus-host disease (GVHD) with no chronic GVHD. Median days of recipients taking immunosuppression were 489; 83% of engrafted patients have discontinued immunosuppression. Haemoglobin, haemolytic parameters and hepatic iron levels improved post HPCT. Pulmonary function testing, hepatic histology and neurovascular imaging remained stable, suggesting cessation of further sickle-related injury. Fourteen patients had children. In this largest group of adult SCD patients, this regimen was highly efficacious, well-tolerated despite compromised organ functions pre HPCT, and without clinically significant GVHD.
- Published
- 2021
30. Associations of hemolysis and anemia with cardiopulmonary dysfunction in an adult sickle cell disease cohort
- Author
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Franklin Njoku, Xu Zhang, Binal N. Shah, Jin Han, Roberto Machado, Santosh L. Saraf, and Victor R. Gordeuk
- Subjects
Biochemistry (medical) ,Clinical Biochemistry ,General Medicine ,Biochemistry - Published
- 2023
31. The nephropathy of sickle cell trait and sickle cell disease
- Author
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Kenneth I. Ataga, Santosh L. Saraf, and Vimal K. Derebail
- Subjects
Adult ,Young Adult ,Nephrology ,Albuminuria ,Humans ,Kidney Diseases ,Anemia, Sickle Cell ,Renal Insufficiency, Chronic ,Apolipoprotein L1 ,Article ,Glomerular Filtration Rate ,Sickle Cell Trait - Abstract
Sickle cell syndromes, including sickle cell disease (SCD) and sickle cell trait (SCT), are associated with multiple kidney abnormalities. Young patients with SCD have elevated effective renal plasma flow and glomerular filtration rates (GFR), which decrease to normal ranges in young adulthood and subnormal levels with advancing age. The pathophysiology of SCD-related nephropathy is multifactorial — oxidative stress, hyperfiltration and glomerular hypertension are all contributing factors. Albuminuria, which is an early clinical manifestation of glomerular damage, is common in individuals with SCD. Kidney function declines more rapidly in individuals with SCD than in those with sickle cell trait or in healthy individuals. Multiple genetic modifiers, including APOL1, HMOX1, HBA1 and HBA2 variants are also implicated in the development and progression of SCD-related nephropathy. Chronic kidney disease and rapid decline in estimated glomerular filtration rate are associated with increased mortality in adults with SCD. Renin–angiotensin–aldosterone system inhibitors are the standard of care treatment of albuminuria in SCD, despite a lack of controlled studies demonstrating their long-term efficacy. Multiple studies of novel therapeutic agents are ongoing, and patients with SCD and kidney failure should be evaluated for kidney transplantation. Given the high prevalence and severe consequences of kidney disease, additional studies are needed to elucidate the pathophysiology, natural history and treatment of SCD-related nephropathy.
- Published
- 2022
32. Voxelotor and albuminuria in adults with sickle cell anaemia
- Author
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Jin Han, Robert E. Molokie, Faiz Hussain, Franklin Njoku, Victor R. Gordeuk, and Santosh L. Saraf
- Subjects
Adult ,Benzaldehydes ,Pyrazines ,Albuminuria ,Humans ,Pyrazoles ,Anemia, Sickle Cell ,Hematology ,Article - Published
- 2022
33. Hyperkalemia and Metabolic Acidosis Occur at a Higher eGFR in Sickle Cell Disease
- Author
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Santosh L. Saraf, Vimal K. Derebail, Xu Zhang, Roberto F. Machado, Victor R. Gordeuk, James P. Lash, and Jane Little
- Subjects
congenital, hereditary, and neonatal diseases and abnormalities ,Cross-Sectional Studies ,hemic and lymphatic diseases ,Creatinine ,Humans ,Hyperkalemia ,General Medicine ,Anemia, Sickle Cell ,urologic and male genital diseases ,Acidosis ,Nutrition Surveys ,Original Investigation ,Glomerular Filtration Rate - Abstract
BACKGROUND: People with sickle cell disease (SCD) have an elevated estimated glomerular filtration rate (eGFR) compared with the general population, and this may alter the usual creatinine-based eGFR cutoffs for which physiologic evidence of kidney dysfunction is apparent. This study aimed to identify eGFR thresholds for hyperkalemia and metabolic acidosis in patients with SCD. METHODS: This was a cross-sectional analysis of 733 patients with severe (hemoglobin SS or Sβ(0)-thalassemia) SCD genotype, 238 patients with moderate (hemoglobin SC or Sβ(+)-thalassemia) SCD genotype, and 1333 age- and sex-matched African Americans from the National Health and Nutrition Examination Survey (NHANES). The prevalence rates of hyperkalemia and metabolic acidosis were compared by eGFR category. Cutoffs for hyperkalemia and metabolic acidosis were determined using generalized additive models. RESULTS: Hyperkalemia and metabolic acidosis were more common in those with severe SCD genotype (13% and 21%, respectively) compared with the NHANES (0.3% and 5%, respectively); the prevalence rates in the moderate SCD genotype were intermediate for hyperkalemia (3%) and metabolic acidosis (11%). The proportion of patients with hyperkalemia and metabolic acidosis progressively increased with lower eGFR category in both SCD genotype groups. The eGFR thresholds for hyperkalemia and metabolic acidosis were higher in the severe (85 and 91 ml/min per 1.73 m(2), respectively) and moderate (52 and 102 ml/min per 1.73 m(2), respectively) SCD genotypes compared with the NHANES (34 and 46 ml/min per 1.73 m(2)). CONCLUSIONS: We demonstrate that hyperkalemia and metabolic acidosis are more common and occur at higher eGFR values in patients with SCD compared with age- and sex-matched African Americans, including in eGFR ranges considered to be normal. Future studies using redefined creatinine-based eGFR thresholds for abnormal kidney function may identify high-risk patients for earlier intervention strategies and referral for specialized renal care in SCD.
- Published
- 2022
34. Antimicrobial resistance is a risk factor for mortality in adults with sickle cell disease
- Author
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Robert E. Molokie, Santosh L. Saraf, Franklin Njoku, Victor R. Gordeuk, Rasha Raslan, Andrew Srisuwananukorn, Michel Gowhari, Jin Han, and Faiz Ahmed Hussain
- Subjects
Adult ,medicine.medical_specialty ,business.industry ,Cell ,MEDLINE ,Anemia, Sickle Cell ,Hematology ,Disease ,Anti-Bacterial Agents ,medicine.anatomical_structure ,Antibiotic resistance ,Risk Factors ,Internal medicine ,Drug Resistance, Bacterial ,medicine ,Humans ,Risk factor ,Letters to the Editor ,business - Abstract
Not available.
- Published
- 2020
35. Systematic Review of Crizanlizumab: A New Parenteral Option to Reduce Vaso‐occlusive Pain Crises in Patients with Sickle Cell Disease
- Author
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Santosh L. Saraf, Victor R. Gordeuk, and Jin Han
- Subjects
0301 basic medicine ,congenital, hereditary, and neonatal diseases and abnormalities ,medicine.medical_specialty ,Glutamine ,030106 microbiology ,MEDLINE ,Pain ,Subgroup analysis ,Anemia, Sickle Cell ,Disease ,030204 cardiovascular system & hematology ,Antibodies, Monoclonal, Humanized ,Placebo ,03 medical and health sciences ,0302 clinical medicine ,hemic and lymphatic diseases ,Internal medicine ,medicine ,Animals ,Humans ,Hydroxyurea ,Pharmacology (medical) ,Randomized Controlled Trials as Topic ,business.industry ,Incidence (epidemiology) ,medicine.disease ,Sickle cell anemia ,Clinical trial ,P-Selectin ,Concomitant ,business - Abstract
Hydroxyurea, indicated for managing sickle cell anemia (SCA), and L-glutamine, indicated for treating sickle cell disease (SCD), were the only pharmacotherapeutic options in this patient population before the approval of crizanlizumab by the U.S. Food and Drug Administration in November 2019 to reduce vaso-occlusive crisis (VOC) frequency. This article reviews the evidence pertaining to crizanlizumab in SCD by searching records in Medline, Embase, and International Pharmaceutical Abstracts. Crizanlizumab, a P-selectin inhibitor, mitigates the microvascular vaso-occlusion in SCD. In the multicenter randomized double-blind SUSTAIN trial, a higher dose of crizanlizumab decreased the incidence of VOCs by 45% and prolonged the median time to the first and second VOC. A post hoc subgroup analysis demonstrated that the proportion of patients who had no VOC incidence during the study period was greater in the crizanlizumab group, and this benefit was consistent regardless of concomitant hydroxyurea use, prior categorized history of VOC frequency, or SCD genotype. Crizanlizumab had a safety profile comparable with placebo. Multiple ongoing clinical trials are trying to establish its roles in pediatric patients with SCD and its effects on alleviating other SCD-related complications. As the first parenteral option for SCD, providers need to formulate administration logistics to improve patients' access to crizanlizumab. Current available data suggest crizanlizumab is a promising agent to reduce VOC in patients with SCD.
- Published
- 2020
36. Systematic Review of Voxelotor: A First‐in‐Class Sickle Hemoglobin Polymerization Inhibitor for Management of Sickle Cell Disease
- Author
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Jin Han, Victor R. Gordeuk, and Santosh L. Saraf
- Subjects
0301 basic medicine ,medicine.medical_specialty ,Hemoglobin, Sickle ,030106 microbiology ,Anemia, Sickle Cell ,Disease ,030204 cardiovascular system & hematology ,Placebo ,Polymerization ,03 medical and health sciences ,0302 clinical medicine ,Pharmacokinetics ,Hematologic Agents ,Internal medicine ,medicine ,Humans ,Pharmacology (medical) ,Adverse effect ,Randomized Controlled Trials as Topic ,Dose-Response Relationship, Drug ,business.industry ,Incidence (epidemiology) ,medicine.disease ,Hemolysis ,Benzaldehydes ,Pyrazines ,Pharmacodynamics ,Pyrazoles ,Hemoglobin ,business ,Biomarkers - Abstract
Voxelotor, a sickle hemoglobin polymerization inhibitor, was approved by the U.S. Food and Drug Administration to treat sickle cell disease (SCD) in November 2019. This article reviews published data about voxelotor treatment of SCD based on a search of MEDLINE, Embase, and International Pharmaceutical Abstracts. In a phase I/II trial, voxelotor demonstrated a dose-dependent pharmacokinetic and pharmacodynamic response and was well tolerated in healthy volunteers and patients with SCD. In a multi-center, randomized, double-blind, phase III trial (HOPE trial), a significantly higher percentage of patients randomized to voxelotor had increased hemoglobin (> 1 g/dl from baseline) compared to placebo. A greater reduction of hemolytic markers was also observed in the voxelotor-treated group, whereas the incidence of adverse effects was comparable. Three case series or reports also demonstrated the efficacy and safety of voxelotor use in a limited number of SCD patients in the real-world situation, although one patient with SCD, severe anemia, and a history of autoantibody-mediated hemolysis failed to respond to voxelotor. An ongoing trial (HOPE-KIDS) is designed to establish the use of voxelotor in younger pediatric patients with SCD. There is a theoretical concern that voxelotor may impair oxygen delivery, due to modification of the oxygen affinity of hemoglobin, which needs to be further evaluated. As a first-in-class hemoglobin modulator, voxelotor offers a new treatment option targeting the root cause of SCD.
- Published
- 2020
37. Thrombomodulin and <scp>multiorgan</scp> failure in sickle cell anemia
- Author
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Maria Armila Ruiz, Binal N. Shah, Guohui Ren, David Shuey, Richard D. Minshall, Victor R. Gordeuk, and Santosh L. Saraf
- Subjects
Male ,Multiple Organ Failure ,Thrombomodulin ,Humans ,Female ,Anemia, Sickle Cell ,Hematology ,Article ,Cell Line - Published
- 2021
38. Black and White Adults With CKD Hospitalized With Acute Kidney Injury: Findings From the Chronic Renal Insufficiency Cohort (CRIC) Study
- Author
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Anthony N. Muiru, Jingrong Yang, Vimal K. Derebail, Kathleen D. Liu, Harold I. Feldman, Anand Srivastava, Zeenat Bhat, Santosh L. Saraf, Teresa K. Chen, Jiang He, Michelle M. Estrella, Alan S. Go, Chi-yuan Hsu, Lawrence J. Appel, Jing Chen, Debbie L. Cohen, James P. Lash, Robert G. Nelson, Mahboob Rahman, Panduranga S. Rao, Vallabh O. Shah, and Mark L. Unruh
- Subjects
Adult ,Angiotensins ,Black People ,Angiotensin-Converting Enzyme Inhibitors ,Acute Kidney Injury ,Apolipoprotein L1 ,White People ,Sickle Cell Trait ,Cohort Studies ,Hospitalization ,Risk Factors ,Nephrology ,Creatinine ,Humans ,Prospective Studies ,Renal Insufficiency, Chronic ,Glomerular Filtration Rate - Abstract
Few studies have investigated racial disparities in acute kidney injury (AKI), in contrast to the extensive literature on racial differences in the risk of kidney failure. We sought to study potential differences in risk in the setting of chronic kidney disease (CKD).Prospective cohort study.We studied 2,720 self-identified Black or White participants with CKD enrolled in the Chronic Renal Insufficiency Cohort (CRIC) Study from July 1, 2013, to December 31, 2017.Self-reported race (Black vs White).Hospitalized AKI (≥50% increase from nadir to peak serum creatinine).Cox regression models adjusting for demographics (age and sex), prehospitalization clinical risk factors (diabetes, blood pressure, cardiovascular disease, estimated glomerular filtration rate, proteinuria, receipt of angiotensin-converting enzyme inhibitors or angiotensin-receptor blockers), and socioeconomic status (insurance status and education level). In a subset of participants with genotype data, we adjusted for apolipoprotein L1 gene (APOL1) high-risk status and sickle cell trait.Black participants (n = 1,266) were younger but had a higher burden of prehospitalization clinical risk factors. The incidence rate of first AKI hospitalization among Black participants was 6.3 (95% CI, 5.5-7.2) per 100 person-years versus 5.3 (95% CI, 4.6-6.1) per 100 person-years among White participants. In an unadjusted Cox regression model, Black participants were at a modestly increased risk of incident AKI (HR, 1.22 [95% CI, 1.01-1.48]) compared with White participants. However, this risk was attenuated and no longer significant after adjusting for prehospitalization clinical risk factors (adjusted HR, 1.02 [95% CI, 0.83-1.25]). There were only 11 AKI hospitalizations among individuals with high-risk APOL1 risk status and 14 AKI hospitalizations among individuals with sickle cell trait.Participants were limited to research volunteers and potentially not fully representative of all CKD patients.In this multicenter prospective cohort of CKD patients, racial disparities in AKI incidence were modest and were explained by differences in prehospitalization clinical risk factors.
- Published
- 2022
39. Effects of Renin-Angiotensin Blockade and
- Author
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Robert E. Molokie, Andrew Srisuwananukorn, Binal N. Shah, Santosh L. Saraf, Victor R. Gordeuk, James P. Lash, and Jin Han
- Subjects
medicine.medical_specialty ,Renin angiotensin system blockade ,Endocrinology ,medicine.anatomical_structure ,business.industry ,Internal medicine ,Cell ,medicine ,Renal function ,Angiotensin Receptor Blockers ,Disease ,business ,Article - Published
- 2021
40. Biomarkers of clinical severity in treated and untreated sickle cell disease: a comparison by genotypes of a single center cohort and African Americans in the NHANES study
- Author
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Santosh L. Saraf, Franklin Njoku, Victor R. Gordeuk, Jin Han, Binal N. Shah, Roberto Machado, and Xu Zhang
- Subjects
Adult ,Male ,medicine.medical_specialty ,National Health and Nutrition Examination Survey ,Genotype ,Disease ,Anemia, Sickle Cell ,Single Center ,Severity of Illness Index ,Article ,Hydroxycarbamide ,Young Adult ,Antisickling Agents ,hemic and lymphatic diseases ,Internal medicine ,medicine ,Humans ,Hydroxyurea ,Blood Transfusion ,business.industry ,Hematology ,Haemolysis ,Black or African American ,Cross-Sectional Studies ,Cohort ,Biomarker (medicine) ,Female ,business ,medicine.drug - Abstract
BACKGROUND. Hemolysis and vaso-occlusion underlie multi-organ system complications in sickle cell disease (SCD). METHODS. We assessed real-world biomarkers in University of Illinois adult SCD patients, categorized as severe (HbSS/Sβ(0)-thalassemia; n=342) or mild (HbSC/Sβ(+)-thalassemia; n=100) genotypes and stratified according to treatment. African-American controls from the National Health and Nutrition Examination Survey (NHANES) were matched with each genotype category. RESULTS. Most measures of hemolysis, anemia, inflammation, and function of kidneys, liver and lungs differed markedly in untreated severe genotype patients compared to NHANES controls. These same biomarkers were significantly closer to the NHANES control range in untreated mild versus severe genotype patients, but they were not improved in severe genotype patients receiving treatment with hydroxyurea or blood transfusions, except that hemoglobin and HbF were higher with hydroxyurea. Systolic blood pressures did not differ among the SCD and NHANES groups, but diastolic pressures were higher in mild genotype patients. Ferritin in severe genotype patients on chronic transfusions was 50-fold higher than NHANES controls. DISCUSSION. The cross-sectional real-world biomarkers of patients on hydroxyurea or transfusions were not markedly improved compared to untreated patients. This may be due partly to poor compliance or more severe disease. Our findings highlight the need for more effective treatments.
- Published
- 2021
41. Race/ethnicity and underlying disease influences hematopoietic stem/progenitor cell mobilization response: A single center experience
- Author
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Yuankai Lin, Damiano Rondelli, Nadim Mahmud, Elena Tepak, Xinhe Wang, Youngmin Park, Sally Campbell-Lee, David Peace, Chukwuemeka Uzoka, Li C Liu, Santosh L. Saraf, Karen Sweiss, and Pritesh R. Patel
- Subjects
Oncology ,Adult ,Male ,medicine.medical_specialty ,CD34 ,Antigens, CD34 ,030204 cardiovascular system & hematology ,Single Center ,Transplantation, Autologous ,Body Mass Index ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,Granulocyte Colony-Stimulating Factor ,medicine ,Ethnicity ,Humans ,Transplantation, Homologous ,Progenitor cell ,Multiple myeloma ,Aged ,Retrospective Studies ,Mobilization ,business.industry ,Plerixafor ,Stem Cells ,Hematopoietic Stem Cell Transplantation ,Hematology ,General Medicine ,Middle Aged ,medicine.disease ,Hematopoietic Stem Cells ,Hematopoietic Stem Cell Mobilization ,United States ,Black or African American ,Haematopoiesis ,Multivariate Analysis ,Blood Component Removal ,Female ,business ,Multiple Myeloma ,Body mass index ,030215 immunology ,medicine.drug - Abstract
Background Whether race/ethnicity plays a role in hematopoietic stem/progenitor cells (HSPC) mobilization in autologous donors has not been studied. We hypothesize that donor characteristic including race/ethnicity, age, sex, body mass index, and diagnostic groups influences HSPC mobilization. Diagnostic groups include healthy allogeneic donors, autologous multiple myeloma (MM) and non-MM donors. Study design and methods Here, we conducted a single-center retrospective study in 64 autologous patients and 48 allogeneic donors. Autologous donors were patients diagnosed with MM or non-MM. All donors were grouped as African American (AA), White (W), or "Other"(O). Results Multivariate analysis demonstrated diagnostic group differences for CD34+ cell yields between race/ethnicity. Specifically, non-MM patients had the lowest CD34+ cell yields in AA and O, but not in W. For pre-apheresis peripheral blood (PB) CD34+ cell numbers, race/ethnicity had a significant effect both in bivariate and multivariate analyses. Non-MM patients had the lowest, and AA patients had the highest PB CD34+ cells. The results support the view that past therapies used in MM are likely more conducive of recovery of HSPC. Conclusions Our study shows that race/ethnicity and diagnostic group differences influenced CD34+ cell mobilization response across donor types. Interestingly, autologous MM donors with the aid of plerixafor displayed comparable CD34 yields to allogeneic donors. Even though both MM and non-MM donors received plerixafor, non-MM donors had significantly lower CD34 yields among AA and O donors but not in W donors. Larger studies would be required to validate the role of diagnostic groups and race/ethnicity interactions.
- Published
- 2021
42. Potential Contribution of Pulmonary Thromboembolic Disease in Pulmonary Hypertension in Sickle Cell Disease
- Author
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Victor R. Gordeuk, Roberto F. Machado, Mark T. Gladwin, Mehdi Nouraie, Xu Zhang, Andrew Srisuwananukorn, and Santosh L. Saraf
- Subjects
Adult ,Male ,Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,business.industry ,Hypertension, Pulmonary ,Cell ,Anemia, Sickle Cell ,Disease ,Middle Aged ,medicine.disease ,Pulmonary hypertension ,Young Adult ,medicine.anatomical_structure ,Internal medicine ,Cardiology ,Humans ,Medicine ,Female ,Thromboembolic disease ,Letters ,Longitudinal Studies ,Pulmonary Embolism ,business - Published
- 2020
43. Similar burden of type 2 diabetes among adult patients with sickle cell disease relative to African Americans in the U.S. population: a six‐year population‐based cohort analysis
- Author
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William L. Galanter, Victor R. Gordeuk, Gregory S. Calip, Jifang Zhou, Jin Han, Santosh L. Saraf, Surrey M. Walton, and Edith A. Nutescu
- Subjects
medicine.medical_specialty ,education.field_of_study ,endocrine system diseases ,National Health and Nutrition Examination Survey ,business.industry ,Incidence (epidemiology) ,Hazard ratio ,Population ,nutritional and metabolic diseases ,Hematology ,Type 2 diabetes ,medicine.disease ,Article ,Confidence interval ,03 medical and health sciences ,0302 clinical medicine ,030220 oncology & carcinogenesis ,Diabetes mellitus ,Internal medicine ,Epidemiology ,medicine ,education ,business ,030215 immunology - Abstract
Conflicting evidence exists on the epidemiology of type 2 diabetes mellitus (T2DM) among patients with sickle cell disease (SCD). This study measured the prevalence, incidence and clinical outcomes associated with T2DM in a large US population of commercially-insured adults aged ≥20 years with SCD between 2009 and 2014. Among 7070 patients with SCD, the mean age (median) was 39 (37) years and 60·8% were female. The standardized prevalence of T2DM among patients with SCD showed a modest increase, from 15·7% to 16·5% (P trend = 0·026), and was comparable to African-American respondents to the National Health and Nutrition Examination Survey (18·2%). Over 17 024 person-years, the crude incidence rate for T2DM was 25·4 per 1000 person-years. Incident T2DM was associated with comorbid hypertension (hazard ratio [HR] = 1·45, 95% confidence interval [CI] 1·14-1·83), and dyslipidaemia (HR = 1·43, 95%CI 1·04-1·96). Compared to SCD patients without T2DM, more SCD patients with T2DM had diagnoses of nephropathy (28·0% vs. 9·5%; P < 0·001), neuropathy (17·7% vs. 5·2%; P < 0·001) and stroke (24·1% vs. 9·2%; P < 0·001). Prevalence of T2DM in SCD patients is similar to the general African American population with an increasing trend in recent years. These trends support routine screening for T2DM in aging patients with SCD, especially those with comorbid hypertension and/or dyslipidaemia.
- Published
- 2019
44. The vasculopathic cord between pre-eclampsia and kidney function in sickle cell disease
- Author
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Santosh L. Saraf
- Subjects
Pathology ,medicine.medical_specialty ,Eclampsia ,Cord ,business.industry ,Cell ,Renal function ,Hematology ,Disease ,Anemia, Sickle Cell ,medicine.disease ,Fetal Blood ,Kidney ,medicine.anatomical_structure ,Pre-Eclampsia ,Pregnancy ,medicine ,Humans ,Female ,Vascular Diseases ,business - Published
- 2021
45. Comparing the Effectiveness of Education Versus Digital Cognitive Behavioral Therapy for Adults With Sickle Cell Disease: Protocol for the Cognitive Behavioral Therapy and Real-time Pain Management Intervention for Sickle Cell via Mobile Applications (CaRISMA) Study
- Author
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Sherif M Badawy, Kaleab Z Abebe, Charlotte A Reichman, Grace Checo, Megan E Hamm, Jennifer Stinson, Chitra Lalloo, Patrick Carroll, Santosh L Saraf, Victor R Gordeuk, Payal Desai, Nirmish Shah, Darla Liles, Cassandra Trimnell, and Charles R Jonassaint
- Subjects
medicine.medical_specialty ,020205 medical informatics ,medicine.medical_treatment ,Computer applications to medicine. Medical informatics ,R858-859.7 ,Psychological intervention ,CBT ,02 engineering and technology ,03 medical and health sciences ,0302 clinical medicine ,Quality of life (healthcare) ,depressive symptoms ,sickle cell anemia ,Acute care ,0202 electrical engineering, electronic engineering, information engineering ,medicine ,Protocol ,pain ,Disease burden ,education ,mobile phone ,business.industry ,digital ,General Medicine ,Mental health ,cognitive behavioral therapy ,Cognitive behavioral therapy ,Clinical trial ,quality of life ,mHealth ,030220 oncology & carcinogenesis ,depression ,Physical therapy ,Medicine ,sickle cell disease ,eHealth ,Outcomes research ,business - Abstract
BACKGROUND Patients with sickle cell disease (SCD) experience significant medical and psychological stressors that affect their mental health, well-being, and disease outcomes. Digital cognitive behavioral therapy (CBT) has been used in other patient populations and has demonstrated clinical benefits. Although evidence-based, nonpharmacological interventions for pain management are widely used in other populations, these treatments have not been well studied in SCD. Currently, there are no adequately powered large-scale clinical trials to evaluate the effectiveness and dissemination potential of behavioral pain management for adults with SCD. Furthermore, some important details regarding behavioral therapies in SCD remain unclear—in particular, what works best for whom and when. OBJECTIVE Our primary goal is to compare the effectiveness of two smartphone–delivered programs for reducing SCD pain symptoms: digital CBT versus pain and SCD education (Education). Our secondary goal is to assess whether baseline depression symptoms moderate the effect of interventions on pain outcomes. We hypothesize that digital CBT will confer greater benefits on pain outcomes and depressive symptoms at 6 months and a greater reduction in health care use (eg, opioid prescriptions or refills or acute care visits) over 12 months. METHODS The CaRISMA (Cognitive Behavioral Therapy and Real-time Pain Management Intervention for Sickle Cell via Mobile Applications) study is a multisite comparative effectiveness trial funded by the Patient-Centered Outcomes Research Institute. CaRISMA is conducted at six clinical academic sites, in partnership with four community-based organizations. CaRISMA will evaluate the effectiveness of two 12-week health coach–supported digital health programs with a total of 350 participants in two groups: CBT (n=175) and Education (n=175). Participants will complete a series of questionnaires at baseline and at 3, 6, and 12 months. The primary outcome will be the change in pain interference between the study arms. We will also evaluate changes in pain intensity, depressive symptoms, other patient-reported outcomes, and health care use as secondary outcomes. We have 80% power to detect a difference of 0.37 SDs between study arms on 6-month changes in the outcomes with 15% expected attrition at 6 months. An exploratory analysis will examine whether baseline depression symptoms moderate the effect of the intervention on pain interference. RESULTS This study will be conducted from March 2021 through February 2022, with results expected to be available in February 2023. CONCLUSIONS Patients with SCD experience significant disease burden, psychosocial stress, and impairment of their quality of life. CaRISMA proposes to leverage digital technology and overcome barriers to the routine use of behavioral treatments for pain and depressive symptoms in the treatment of adults with SCD. The study will provide data on the comparative effectiveness of digital CBT and Education approaches and evaluate the potential for implementing evidence-based behavioral interventions to manage SCD pain. CLINICALTRIAL ClinicalTrials.gov NCT04419168; https://clinicaltrials.gov/ct2/show/NCT04419168. INTERNATIONAL REGISTERED REPORT PRR1-10.2196/29014
- Published
- 2021
46. Evaluation of point-of-care International Normalized Ratio in sickle cell disease
- Author
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Santosh L. Saraf, Syeda Rahman, Edith A. Nutescu, Franklin Njoku, Victor R. Gordeuk, James C. Lee, Faiz Ahmed Hussain, Andrew Srisuwananukorn, Robert E. Molokie, Jin Han, and Michel Gowhari
- Subjects
medicine.medical_specialty ,endocrine system ,Anemia ,business.industry ,Brief Report ,fungi ,Retrospective cohort study ,Hematology ,Disease ,medicine.disease ,Confidence interval ,Internal medicine ,health services administration ,Cohort ,Linear regression ,medicine ,In patient ,Diseases of the blood and blood-forming organs ,heterocyclic compounds ,Brief Reports ,cardiovascular diseases ,RC633-647.5 ,business ,Point of care - Abstract
Background Point‐of‐care (POC) International Normalized Ratio (INR) measurement provides efficient monitoring of warfarin therapy; however, its reliability may be affected in patients with anemia, such as those with sickle cell disease (SCD). Objectives To evaluate the correlation of POC‐INR to clinical laboratory INR (CL‐INR) in SCD and use of a correction factor. Patient/Methods In this retrospective study, the accuracy of POC‐INR compared to CL‐INR was evaluated in a cohort of patients with SCD and in a non‐SCD Black cohort. Results Despite the difference in anemia, the SCD cohort showed a similar percentage of in‐range POC‐INR values as observed in the non‐SCD cohort (37% vs 42%). The SCD cohort was randomly divided to form discovery and validation cohorts. In the discovery cohort, 86% of POC‐INRs were in range when the POC‐INRs were ˂4.0, but only 24% were in range if POC‐INRs were ≥4.0. A linear regression of CL‐INR versus POC‐INR for POC‐INR values ≥4.0 yielded a coefficient of 0.72 (95% confidence interval, 0.69‐0.75); Multiplying POC‐INR by this correction factor, rounded to 0.7 for ease of use in clinical practice, improved the proportion of in‐range POC‐INR values ≥4.0 from 24% to 100% in the SCD discovery cohort and from 19% to 95% in the SCD validation cohort. Similar findings applied to analyses of the non‐SCD cohort. Conclusions POC‐INR and CL‐INR in patients with SCD are similar when POC‐INR is
- Published
- 2021
47. Real World Outcomes of Sars-Cov-2 Thrombosis Rates across Three University Health Systems in the Chicago Metropolitan Area
- Author
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Diana Kreppel, Stephanie Berg, Katie W. Phelan, Sonam Patel, Yanyu Zhang, Patrick J. Stiff, Kevin Barton, Hanh P. Mai, Elizabeth Elliott, Shuai Qin, Glenda Delgado-Ramos, Nicholas Torgerson, Candice Schwartz, Abhigna Kodali, Erin M. Lowery, Priya Rajakumar, Santosh L. Saraf, Patrick Hagen, Melissa L. Larson, Oluwatobi Odetola, Amy Wozniak, Tracie Watson, Seo-Hyun Kim, James Coggan, Laura Pax, Ahmed Aleem, Rebecca Feltman Frank, Nasheed Hossain, Raymond W. Lee, Patrick Moore, Sucha Nand, Ryan Guerrettaz, Fatema Esmail, Hina Dalal, Ellen Murchie, Saad Arain, Daulath Singh, and Anthi Katsouli
- Subjects
medicine.medical_specialty ,education.field_of_study ,Multivariate analysis ,business.industry ,Deep vein ,Incidence (epidemiology) ,Immunology ,Population ,Cell Biology ,Hematology ,medicine.disease ,Biochemistry ,Thrombosis ,Pulmonary embolism ,Exact test ,medicine.anatomical_structure ,904.Outcomes Research-Non-Malignant Conditions ,Internal medicine ,Cohort ,Medicine ,business ,education - Abstract
Introduction: Initial studies from Wuhan, China reported patients infected with SARS-CoV-2 have uncontrolled coagulopathy and an increased risk for thrombotic complications, including pulmonary embolism (PE), deep vein thrombosis (DVT), and arterial thrombosis.1 The incidence of thrombosis attributed to coronavirus disease 2019 (COVID-19) ranged from 9.5% in all hospital-admitted patients to 31% in the critically ill.2,3 COVID-19 has had a major impact on the Chicago metropolitan area with over 121,000 confirmed cases as of August 2020, Cook county being the 4th highest affected county after Maricopa, Miami-Dade and Los Angeles counties.4 The primary goal of this study is to describe the rate of thrombotic events in the Chicago metropolitan area, highlighting an ethnically diverse population, and identify new risk factors for thrombosis between three university health systems. Methods: We conducted a retrospective analysis between three university health systems in the Chicago metropolitan area: Loyola University Health System (LUHS): comprised of one tertiary and two community hospitals, Rush University System for Health (RUSH): comprised of one tertiary and two community hospitals, and University of Illinois-Chicago (UIC): a tertiary hospital. All patients had positive SARS-CoV-2 testing and were hospitalized for COVID-19. PE, DVT or arterial thrombosis were confirmed by supportive imaging modalities. Wilcoxon rank sum test were used to test the associations of continuous variables; Chi-square test or Fisher's exact test were used to test the associations of categorical variables. All analyses were performed with SAS 9.4 and two-sided p-value < .05 were deemed statistically significant. Results: Between March and May 2020, 2,180 patients from LUHS, RUSH and UIC were hospitalized for COVID-19 and were included in our analysis. Baseline patient demographics are described in Table 1. Race/ethnicity demographics are as follows: Hispanics (H)/ African Americans (AA) represented 47%/17% of LUHS patients, 32%/42% of RUSH patients, and 36%/51% of UIC patients, respectively (Figure 1). Intensive care admissions were needed in 33% of all patients. Documented total thrombotic events are as follows: LUHS = 5.4% (41 VTE/PE, 10 arterial and 5 with both venous and arterial); RUSH = 9.7% (70 VTE/PE, 7 arterial and 4 with both venous/arterial); UIC = 6% (14 VTE/PE, 4 arterial and 0 with both venous/arterial). Patients that developed a thrombotic event were similar by age, sex, and BMI to those without a thrombotic event. Anticoagulation prophylaxis was given to 82% of pts at LUHS and UIC at time of admission. Collectively, those with thrombotic events (N=156) had higher incidence of intensive care admission, elevated white blood cell (WBC) count and a d-dimer >5X upper limit normal (ULN) at presentation. Furthermore, a higher proportion of pts that had a thrombotic event were diabetic at LUHS and RUSH (Table 2). Mortality in COVID-19 patients was 13-16% and patients that had a thrombotic event had a higher risk of death in the RUSH and UIC cohorts. Conclusions: In a racially diverse, multi-institutional cohort of patients, we demonstrate that 7.2% of COVID-19 patients had a thrombotic event. Consistent risk factors for thrombosis across the different centers included an initial d-dimer levels >5X ULN, elevated initial WBC count, diabetes, and being critically ill. Mortality differences and anticoagulation practices between the institutions as well as race/ethnicity differences regarding thrombosis will be explored in future combined multivariate analyses. Finally, based off these risk factors, identification of patients at most risk for thrombosis is needed to reduce the morbidity and mortality when diagnosed with COVID-19. References -Tang et. al. J Thromb Haemost. 2020;18:844-847. -Klock et. Al. Thrombosis Research 2020;191:145-147. -Al-Samkari H, Laef RS, Dzik WH et. Al. COVID-19 and coagulation: bleeding and thrombotic manifestations of SARS-CoV-2 infection. Blood. 2020;136(4):489-500. -https://www.cdc.gov/coronavirus/2019-ncov/cases-updates/county-map.html; accessed 8/7/20. Disclosures Arain: Astellas: Other: Spouse is employed. Stiff:Macrogenics: Research Funding; Delta-Fly: Research Funding; Unum: Research Funding; Atara: Research Funding; Kite, a Gilead Company: Research Funding; Amgen: Research Funding; Gamida Cell: Research Funding. Saraf:Novartis, Global Blood Therapeutics: Membership on an entity's Board of Directors or advisory committees; Global Blood Therapeutics: Membership on an entity's Board of Directors or advisory committees, Other: Advisory Boards, Speakers Bureau; Pfizer, Global Blood Therapeutics, Novartis: Research Funding.
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- 2021
48. Urinary kringle-domain-containing protein HGFL: A validated biomarker of early sickle cell anemia-associated kidney disease
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Santosh L. Saraf, Nathan J. Smith, Victor R. Gordeuk, Xionghao Lin, Marina Jerebtsova, Nowah Afangbedji, Ammanuel Taye, Sergei Nekhai, James G. Taylor, and Simran Soni
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Oncology ,Adult ,Male ,medicine.medical_specialty ,Adolescent ,Urinary system ,Renal function ,Disease ,Anemia, Sickle Cell ,urologic and male genital diseases ,Article ,Young Adult ,Kringles ,Internal medicine ,Proto-Oncogene Proteins ,medicine ,Humans ,Renal Insufficiency, Chronic ,Aged ,business.industry ,Hepatocyte Growth Factor ,Middle Aged ,medicine.disease ,Prognosis ,Sickle cell anemia ,Early Diagnosis ,Nephrology ,Cohort ,Disease Progression ,Biomarker (medicine) ,Female ,Complication ,business ,Biomarkers ,Kidney disease ,Glomerular Filtration Rate - Abstract
Introduction: Chronic kidney disease (CKD) is a prevalent complication of sickle cell anemia (SCA). Hyperfiltration that delayed detection of CKD is common in SCA patients. Identification of novel urinary biomarkers correlating with glomerular filtration rates may help to detect and predict progression of renal disease. Methods: Reanalysis of mass spectra of urinary samples obtained from University of Illinois at Chicago identified kringle domain-containing protein HGFL. Results: HGFL levels correlated with hyperfiltration, were significantly reduced at CKD stage 1 compared to stage 0, negatively correlated with progression of CKD and were suitable for differentiation of stage 1. Better prediction of CKD progression to stage 2 was observed for HGFL-based risk prediction compared to the estimated glomerular filtration rate (eGFR)-based prediction. Results from a Howard University patient cohort supported the utility of HGFL-based test for the differentiation of stage 1 of CKD. Conclusion: Urinary HGFL may contribute additional information beyond eGFR and improve diagnosis of early-stage CKD in SCA patients.
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- 2021
49. Association of Blood Pressure Genetic Risk Score with Cardiovascular Disease and CKD Progression: Findings from the CRIC Study
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Jordana B. Cohen, Tanika N. Kelly, Afshin Parsa, Amanda H. Anderson, Jiang He, Santosh L. Saraf, Anand Srivastava, Sylvia E. Rosas, Cric Study Investigators, Mahboob Rahman, and Jovia L. Nierenberg
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medicine.medical_specialty ,Population ,Renal function ,Blood Pressure ,Risk Factors ,Internal medicine ,medicine ,Humans ,Myocardial infarction ,Prospective Studies ,Renal Insufficiency, Chronic ,education ,Original Investigation ,education.field_of_study ,business.industry ,General Medicine ,medicine.disease ,Confidence interval ,Pulse pressure ,Blood pressure ,Cardiovascular Diseases ,Heart failure ,Cardiology ,Disease Progression ,business ,Kidney disease ,Glomerular Filtration Rate - Abstract
Background: In the general population, genetic risk for elevated blood pressure has been associated with cardiovascular disease but not kidney function or incident chronic kidney disease. These relationships have not been studied longitudinally in participants with chronic kidney disease. We examined whether blood pressure genetic risk predicts cardiovascular disease and kidney disease progression in patients with chronic kidney disease. Methods: We included 1,493 African and 1,581 European ancestry participants from the Chronic Renal Insufficiency Cohort who were followed for 12 years. We examined associations of blood pressure genetic risk scores with development of cardiovascular disease (myocardial infarction, congestive heart failure, or stroke) and chronic kidney disease progression (incident end stage kidney disease or halving of estimated glomerular filtration rate) using Cox proportional hazards models. Analyses were stratified by race and included adjustment for age, sex, study site, and ancestry principal components. Results: Each standard deviation increase in systolic blood pressure and pulse pressure genetic risk score conferred respective 15% [95% confidence interval: 4%, 27%] and 11% (95% confidence interval: 1%, 23%) higher risks of cardiovascular disease, with a similar marginally significant trend for diastolic blood pressure, among European ancestry participants. Among African ancestry participants, each standard deviation increase in systolic and diastolic blood pressure genetic risk score conferred 10% (95% confidence interval: 1%, 20%) and 9% (95% confidence interval: 0%, 18%) higher risk of cardiovascular disease. Higher genetic risk was not associated with chronic kidney disease progression. Conclusions: Genetic risk for elevation in blood pressure was associated with increased risk of cardiovascular disease but not chronic kidney disease progression.
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- 2020
50. Rapid decline in estimated glomerular filtration rate in sickle cell anemia: results of a multicenter pooled analysis
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Allison E. Ashley-Koch, Melanie E. Garrett, Qingning Zhou, Santosh L. Saraf, Kenneth I. Ataga, Vimal K. Derebail, Laura R. Loehr, Jane S. Hankins, Jianwen Cai, and Marilyn J. Telen
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medicine.medical_specialty ,business.industry ,Renal function ,Hematology ,Anemia, Sickle Cell ,medicine.disease ,Gastroenterology ,Sickle cell anemia ,Text mining ,Pooled analysis ,Internal medicine ,medicine ,Humans ,business ,Letters to the Editor ,Glomerular Filtration Rate - Abstract
Not available.
- Published
- 2020
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