Hydroxyurea's Effects on the Kidneys in Sickle Cell Disease

Management in Chronic Kidney Disease

The American Society of Hematology suggests combining hydroxyurea with erythropoiesis-stimulating agents (ESAs) in sickle cell disease patients with chronic kidney disease and worsening anemia to counteract treatment-related anemia while maintaining disease-modifying therapy 1, 2
Hemoglobin must be maintained ≤10 g/dL (hematocrit ≤30%) when using combination therapy to prevent hyperviscosity, vaso-occlusive complications, stroke, and venous thromboembolism 1, 2, 3
ESAs allow more aggressive hydroxyurea dosing by counteracting anemia, potentially slowing progression of end-organ damage including kidney disease 1, 2
Only 1 of 56 patients (1.8%) experienced worsening sickle cell symptoms with combination therapy, suggesting a favorable safety profile 1

Bone marrow suppression is the most common dose-limiting toxicity but typically resolves within 2 weeks of temporary drug discontinuation, and close hematologic monitoring is essential, particularly in renal impairment 4, 3
NT-pro-BNP measurements for risk stratification in sickle cell disease may be misleading in patients with renal insufficiency 4