title: Effect of MTHFR C677T genotype on survival in type 2 diabetes patients with end-stage diabetic nephropathy.
abstract: BACKGROUND
  The MTHFR C677T single nucleotide polymorphism TT genotype is associated with increased levels of plasma homocysteine and possibly an effect on cardiovascular mortality. We evaluated the effect of C677T genotype on mortality in a large end-stage renal disease (ESRD) cohort.
  
  
  METHODS
  C677T genotype was determined in 439 Caucasians with end-stage diabetic nephropathy (DNP) (cases) recruited from 30 dialysis centres in Southern Germany. A total of 482 type 2 diabetes patients without DNP (no microalbuminuria) at inclusion served as a genotype control collective. Patients were prospectively followed for 4 years. Primary endpoint was all-cause mortality.
  
  
  RESULTS
  In contrast to controls, the genotype distribution in cases was not in Hardy-Weinberg equilibrium (HWE, P = 0.003), due to a less than expected number of patients with the TT genotype. The requirements of HWE were met in cases with < 2 years dialysis therapy prior to study inclusion (n = 219). TT genotype was associated with a decreased body mass index (P = 0.002) and long diabetes duration in dialysis patients (P = 0.03). However, TT genotype was not associated with an increased risk of all-cause or cardiac mortality in the total dialysis collective or the subgroup. Also, we observed no association of MTHFR genotype with cardiovascular morbidity in cases or controls (P > 0.05), or with an increased rate of progression to novel microalbuminuria.
  
  
  CONCLUSIONS
  MTHFR 677TT genotype was significantly underrepresented in patients with ESRD in our study, but was not associated with premature mortality in these patients. We found no evidence for survival bias due to C677T genotype in the ESRD cohort, or bias due to genetically determined accelerated progression to novel microalbuminuria in the controls. However, we cannot exclude that the TT genotype protects from progression from microalbuminuria to more advanced stages of DNP, or that TT genotype is associated with premature mortality before a patient progresses to ESRD.
authors.affiliation: Klinik und Poliklinik für Innere Medizin II, Klinikum der Universität Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany. carsten.boeger@klinik.uni-regensburg.de
authors.forename: Carsten A
authors.initials: CA
authors.lastname: Böger
authors.forename: Mike
authors.initials: M
authors.lastname: Stubanus
authors.forename: Thomas
authors.initials: T
authors.lastname: Haak
authors.forename: Angela K
authors.initials: AK
authors.lastname: Götz
authors.forename: Johanna
authors.initials: J
authors.lastname: Christ
authors.forename: Ute
authors.initials: U
authors.lastname: Hoffmann
authors.forename: Günter A J
authors.initials: GA
authors.lastname: Riegger
authors.forename: Bernhard K
authors.initials: BK
authors.lastname: Krämer
mesh_terms: D015331:Cohort Studies; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000235:genetics* / Q000401:mortality*; D003928:Diabetic Nephropathies / Q000235:genetics* / Q000401:mortality*; D019587:Dietary Supplements; D018450:Disease Progression; D005260:Female; D005838:Genotype; D006710:Homocysteine / Q000097:blood; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications*; D008297:Male; D042965:Methylenetetrahydrofolate Reductase (NADPH2) / Q000235:genetics* / Q000502:physiology*; D010641:Phenotype; D020641:Polymorphism, Single Nucleotide; D013997:Time Factors
chemical_list: D006710:Homocysteine; D042965:Methylenetetrahydrofolate Reductase (NADPH2)