title: Genetic studies in chronic kidney disease: interpretation and clinical applicability.
abstract: The tools of modern molecular biology are evolving rapidly, resulting in vastly more efficient approaches to illuminating human genetic variations and their effects on common multifactorial disorders such as chronic kidney disease (CKD). Indeed, candidate gene association studies and genome-wide association studies (GWASs) have generated novel genetic variants in previously unrecognized biological pathways, highlighting disease mechanisms with a potential role in CKD etiology, morbidity and mortality. Nephrologists now need to find ways to make use of these advancements and meet the increasingly stringent requirements for valid study design, data handling and interpretation of genetic studies. Adding to our prior article in this journal, which introduced the basics of genotype-phenotype association studies in CKD, this second article focuses on how to ascertain robust and reproducible findings by applying adequate methodological and statistical approaches to genotype-phenotype studies in CKD populations. Moreover, this review will briefly discuss genotype-based risk prediction, pharmacotherapy, drug target identification and individualized treatment solutions, specifically highlighting potentially important findings in CKD patients. This increased knowledge will hopefully facilitate the exciting transition from conventional clinical medicine to gene-based medicine. However, before this can be accomplished, unsolved issues regarding the complex human genetic architecture as well technical and clinically oriented obstacles will have to be overcome. Additionally, new policies and standardized risk evaluations for genetic testing in the clinical setting will have to be established to guarantee that CKD patients are provided with high-quality genotype-guided counseling that will help to improve their poor outcomes.
authors.affiliation: Divisions of Renal Medicine and Baxter Novum, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden. anna.witasp@ki.se
authors.forename: Anna
authors.initials: A
authors.lastname: Witasp
authors.forename: Louise
authors.initials: L
authors.lastname: Nordfors
authors.forename: Juan Jesus
authors.initials: JJ
authors.lastname: Carrero
authors.forename: Karin
authors.initials: K
authors.lastname: Luttropp
authors.forename: Bengt
authors.initials: B
authors.lastname: Lindholm
authors.forename: Martin
authors.initials: M
authors.lastname: Schalling
authors.forename: Peter
authors.initials: P
authors.lastname: Stenvinkel
mesh_terms: D000818:Animals; D003661:Decision Support Techniques; D056726:Genetic Association Studies; D005817:Genetic Counseling; D005819:Genetic Markers; D020022:Genetic Predisposition to Disease; D005820:Genetic Testing; D006801:Humans; D010597:Pharmacogenetics; D010641:Phenotype; D057285:Precision Medicine; D011237:Predictive Value of Tests; D011379:Prognosis; D051436:Renal Insufficiency, Chronic / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology / Q000235:genetics*; D015203:Reproducibility of Results; D012307:Risk Factors
chemical_list: D005819:Genetic Markers