Time to Recognize an Overlooked Trait

Abstract

In this era of identifying genetic risk factors for kidney disease, it may be appropriate to revisit one of the most common genetic disorders: Sickle cell hemoglobinopathies. Although sickle cell disease is a rare cause of ESRD, there is only a limited literature examining sickle cell trait (HbAS) in advanced kidney disease. In fact, in the most recent US Renal Data System report describing the primary cause of incident ESRD from 2003 through 2007, sickle cell trait accounted only for 29 of 536,877 cases.1 Progressive chronic kidney disease (CKD) leading to ESRD is often not included in the description of kidney injury resulting from sickle cell trait.2 Considering that the reasons behind the racial disparity of progression of kidney disease and ESRD remain unknown, it seems an obvious hypothesis to consider a widely known genetic disorder such as sickle cell trait. In this issue of JASN , Derebail et al. 3 describe the prevalence of HbAS in a sample of black patients who had ESRD and were receiving either hemodialysis or peritoneal dialysis. They then compare this observed prevalence with that of newborn screening programs in local counties and report the prevalence of HbAS in maintenance dialysis patients to be twice that of the newborn screening programs. The authors also characterize the prevalence of heterozygous hemoglobin …