Kidney Function Decline in Sickle Cell Disease: Associations with Renin Angiotensin System Inhibitors

Sickle cell disease causes accelerated kidney function decline, yet proven GFRpreserving therapies remain elusive. In this two-center, propensity score-matched study of 358 adults with sickle cell disease, RASi use was not associated with a significant difference in the rate of eGFR decline compared with no treatment (−0.15 mL/min/year; 95% CI, −1.67 to +1.36; p = 0.84). This null finding was robust across sensitivity analyses excluding missing albuminuria and low dose RASi. These results highlight the limitations of observational data and underscore the urgent need for prospective randomized trials targeting GFR preservation in sickle cell disease.