title: ACE I/D polymorphism is associated with mortality in a cohort study of patients starting with dialysis.
abstract: 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.
authors.affiliation: Department of Clinical Epidemiology, Leiden University Medical Center, The Netherlands. sman@lumc.nl
authors.forename: Femke
authors.initials: F
authors.lastname: van der Sman-de Beer
authors.forename: Claudia
authors.initials: C
authors.lastname: Verhagen
authors.forename: Saskia M
authors.initials: SM
authors.lastname: Rombach
authors.forename: Peter
authors.initials: P
authors.lastname: Boorsma
authors.forename: Jeannette G
authors.initials: JG
authors.lastname: van Manen
authors.forename: Johanna C
authors.initials: JC
authors.lastname: Korevaar
authors.forename: Ruud
authors.initials: R
authors.lastname: van den Bogaard
authors.forename: Elisabeth W
authors.initials: EW
authors.lastname: Boeschoten
authors.forename: Raymond T
authors.initials: RT
authors.lastname: Krediet
authors.forename: Gerjan J
authors.initials: GJ
authors.lastname: Navis
authors.forename: Jan P
authors.initials: JP
authors.lastname: Vandenbroucke
authors.forename: Friedo W
authors.initials: FW
authors.lastname: Dekker
mesh_terms: 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
chemical_list: D007703:Peptidyl-Dipeptidase A