ACE I/D polymorphism is associated with mortality in a cohort study of patients starting with dialysis.
BACKGROUND
In dialysis patients, only a few follow-up studies have addressed the relationship between the insertion/deletion (I/D) polymorphism in the angiotensin-converting enzyme (ACE) gene and mortality, but the available data are contradictory.


METHODS
A cohort of 453 consecutive patients starting dialysis between January 1999 and January 2002 and participating in a Dutch multicenter prospective study was examined. Patients who died within 3 months after the start of dialysis were excluded. Patients were followed until date of death or censoring in November 2003.


RESULTS
The ACE II, ID, and DD genotype frequencies were 24.3% (N = 110), 50.1% (N = 227), and 25.6% (N = 116). Besides a slightly higher number of Caucasians in the DD group, all other patient characteristics of the 3 ACE groups were similar at the start of dialysis. After adjustment for age, comorbidity, and ethnic background, patients with the ID and DD genotype showed an increased hazard ratio (HR) for all-cause mortality of 1.55 (95% CI 1.00-2.42) and 2.30 (95% CI 1.41-3.75), compared to patients with the II genotype. Slightly lower HRs were found for cardiovascular mortality. All groups of primary kidney disease showed a 2- to 3-fold increased adjusted HR for DD.


CONCLUSIONS
The DD genotype identifies dialysis patients at an increased risk for mortality.
van der Sman-de Beer
Femke
F
Department of Clinical Epidemiology, Leiden University Medical Center, The Netherlands. sman@lumc.nl
Verhagen
Claudia
C
Rombach
Saskia M
SM
Boorsma
Peter
P
van Manen
Jeannette G
JG
Korevaar
Johanna C
JC
van den Bogaard
Ruud
R
Boeschoten
Elisabeth W
EW
Krediet
Raymond T
RT
Navis
Gerjan J
GJ
Vandenbroucke
Jan P
JP
Dekker
Friedo W
FW
D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D020022:Genetic Predisposition to Disease / Q000453:epidemiology; D005838:Genotype; D006801:Humans; D007676:Kidney Failure, Chronic / Q000235:genetics* / Q000401:mortality* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D007703:Peptidyl-Dipeptidase A / Q000235:genetics*; D010530:Peritoneal Dialysis / Q000401:mortality*; D011110:Polymorphism, Genetic; D011446:Prospective Studies; D006435:Renal Dialysis / Q000401:mortality*; D012307:Risk Factors; D016019:Survival Analysis
D007703:Peptidyl-Dipeptidase A