The D allele of angiotensin-converting enzyme polymorphism as a predictor of renal function decline over 4 years in an apparently healthy Chinese population aged 60 and older.
OBJECTIVE
To test the association between angiotensin-converting enzyme (ACE) insertion or deletion (I/D) polymorphism and decline of renal function in people aged 60 and older.


METHODS
Population-based prospective study with 4-year follow-up.


METHODS
Department of Internal Medicine and Family Medicine, Kaohsiung Medical University (KMU) Hospital and Graduate Institute of Medicine and Public Health, KMU.


METHODS
Of 1,500 people screened, 193 subjects were enrolled, and 144 completed 4 years of follow-up, 112 non-diabetic normotensive elderly people were analyzed.


METHODS
Subjects received biochemistry examination at baseline and at 2- and 4-year follow-ups. Serum creatinine and calculated renal parameters, including the Cockroft-Gault (CG) formula, the Jelliffe formula, and the Modification of Diet in Renal Disease (MDRD) Study equation, were used. Genetic polymorphism was analyzed according to the polymerase chain reaction.


RESULTS
The mean age+/-standard deviation of the subjects was 71.9+/-3.7 (range 60-81). Serum creatinine, CG creatinine clearance (CrCl), Jelliffe CrCl, and MDRD glomerular filtration rate (GFR) were significantly lower at the 2- and 4-year follow-ups (all P < or = .001). At the 4-year follow-up, the magnitude of declines of the above four renal parameters was significantly higher in subjects with the ACE D allele than in the non-D-allele carriers (P = .01, .01, .04, and .01 for creatinine, CG CrCl, Jelliffe CrCl, and MDRD GFR, respectively). This association was still significant in multivariate analyses (P < or = .02 for all parameters).


CONCLUSIONS
This longitudinal study showed the ACE I/D gene polymorphism might modulate renal function decline in elderly Chinese. This provides further knowledge essential in the assessment of renal disease and determination of renal function in older Chinese.
Lee
Ya-Ting
YT
Division of Nephrology, Department of Pediatrics, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.
Chiu
Herng-Chia
HC
Su
Ho-Ming
HM
Voon
Wen-Chol
WC
Lin
Tsung-Hsien
TH
Lai
Wen-Ter
WT
Sheu
Sheng-Hsiung
SH
D000368:Aged; D000369:Aged, 80 and over; D000483:Alleles; D002681:China / Q000453:epidemiology; D003404:Creatinine / Q000378:metabolism; D004247:DNA / Q000235:genetics*; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D020022:Genetic Predisposition to Disease; D005919:Glomerular Filtration Rate; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D007703:Peptidyl-Dipeptidase A / Q000097:blood / Q000235:genetics*; D016133:Polymerase Chain Reaction; D011110:Polymorphism, Genetic; D011446:Prospective Studies; D012016:Reference Values; D051437:Renal Insufficiency / Q000201:enzymology* / Q000453:epidemiology / Q000235:genetics; D013053:Spectrophotometry; D013997:Time Factors
D004247:DNA; D003404:Creatinine; D007703:Peptidyl-Dipeptidase A