Survival and Predictive Factors of Lethality in Hemodyalisis: D/I Polymorphism of The Angiotensin I-Converting Enzyme and of the Angiotensinogen M235T Genes

Abstract

BackgroundEnd-stage kidney disease patients continue to have markedly increased cardiovascular disease morbidity and mortality. Analysis of genetic factors connected with the renin-angiotensin system that influences the survival of the patients with end-stage kidney disease supports the ongoing search for improved outcomes.ObjectiveTo assess survival and its association with the polymorphism of renin-angiotensin system genes: angiotensin I-converting enzyme insertion/deletion and angiotensinogen M235T in patients undergoing hemodialysis.MethodsOur study was designed to examine the role of renin-angiotensin system genes. It was an observational study. We analyzed 473 chronic hemodialysis patients in four dialysis units in the state of Rio de Janeiro. Survival rates were calculated by the Kaplan-Meier method and the differences between the curves were evaluated by Tarone-Ware, Peto-Prentice, and log rank tests. We also used logistic regression analysis and the multinomial model. A p value ≤ 0.05 was considered to be statistically significant. The local medical ethics committee gave their approval to this study.ResultsThe mean age of patients was 45.8 years old. The overall survival rate was 48% at 11 years. The major causes of death were cardiovascular diseases (34%) and infections (15%). Logistic regression analysis found statistical significance for the following variables: age (p = 0.000038), TT angiotensinogen (p = 0.08261), and family income greater than five times the minimum wage (p = 0.03089), the latter being a protective factor.ConclusionsThe survival of hemodialysis patients is likely to be influenced by the TT of the angiotensinogen M235T gene.

Handgrip Strength is more associated with blood glucose than ACE and AGT polymorphisms in hemodialysus patients

“…Additionally, the polymorphism of the AGT M235T has the T allele and negative agent, facilitating the increase of proteinuria (Baboolal et al 1997;Pei et al 1997), a negative predictive of ESRD (Anbazhagan et al 2009;Frimat et al 2000;Zhou et al 2013) and left ventricular hypertrophy (Wang et al 2003). In CKD, the T allele negatively impacts patient survival (Alves et al 2014) and is also described as being relevant in the heredity of diabetic nephropathy (Rogus et al 1998).…”

Angiotensin-related genetic determinants of cardiovascular disease in patients undergoing hemodialysis

“…Associations with the InDel and cardiovascular events in patients undergoing dialysis have been contradictory: the InDel was not associated with LVH in populations from Turkey or China, but was associated with LVH and cardiovascular events in Japanese patients [25,26]. In the Netherlands, the DD genotype was associated with mortality in patients receiving dialysis but it was not in similarly sized studies in Italy and Brazil [27]. This InDel is reported to be in high linkage disequilibrium with rs4343 in EA populations, such that the A allele of rs4343 tags the Insertion allele, which acted in a protective fashion, and the G allele tags the Deletion allele, the risk allele as reported above [28,29].…”

Causas de Óbito de pacientes com Insuficiência Renal Crônica em Hemodiálise

“…Assim, temos como função primordial é que é o primeiro a cobrir estes pontos. Dos 473 pacientes em hemodiálise analisados por Alves et al (2014) no Rio de Janeiro, houve maior prevalência (50,1%) do sexo masculino, com média de idade no início hemodiálise de 46 anos, fato que gera grande impacto social, já que é uma faixa etária economicamente ativa, e que devido ao tratamento, deixam muitas vezes de exercer suas atividades laborais. A população estudada era constituída por fumantes e não fumantes, portadores de HAS e DM, geralmente associadas.…”