Highlight
– Renin-angiotensin-aldosterone system inhibitors (RAASi) are commonly used to manage albuminuria in sickle cell disease (SCD) but may worsen anemia.
– Cross-sectional and longitudinal human studies associate RAASi use with reduced hemoglobin levels independent of other therapies.
– Experimental SCD mouse models demonstrate anemia exacerbation linked to impaired bone marrow erythropoiesis under RAASi treatment.
– Hemoglobin concentration should be closely monitored in patients with SCD receiving RAAS inhibitors to balance kidney benefits with anemia risk.
