title: Survival and predictive factors of lethality in hemodialysis: D/I polymorphism of the angiotensin I-converting enzyme and of the angiotensinogen M235T genes.
abstract: BACKGROUND
  End-stage kidney disease patients continue to have markedly increased cardiovascular disease morbidity and mortality. Analysis of genetic factors connected with the renin-angiotensin system that influences the survival of the patients with end-stage kidney disease supports the ongoing search for improved outcomes.
  
  
  OBJECTIVE
  To assess survival and its association with the polymorphism of renin-angiotensin system genes: angiotensin I-converting enzyme insertion/deletion and angiotensinogen M235T in patients undergoing hemodialysis.
  
  
  METHODS
  Our study was designed to examine the role of renin-angiotensin system genes. It was an observational study. We analyzed 473 chronic hemodialysis patients in four dialysis units in the state of Rio de Janeiro. Survival rates were calculated by the Kaplan-Meier method and the differences between the curves were evaluated by Tarone-Ware, Peto-Prentice, and log rank tests. We also used logistic regression analysis and the multinomial model. A p value ≤ 0.05 was considered to be statistically significant. The local medical ethics committee gave their approval to this study.
  
  
  RESULTS
  The mean age of patients was 45.8 years old. The overall survival rate was 48% at 11 years. The major causes of death were cardiovascular diseases (34%) and infections (15%). Logistic regression analysis found statistical significance for the following variables: age (p = 0.000038), TT angiotensinogen (p = 0.08261), and family income greater than five times the minimum wage (p = 0.03089), the latter being a protective factor.
  
  
  CONCLUSIONS
  The survival of hemodialysis patients is likely to be influenced by the TT of the angiotensinogen M235T gene.
authors: Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil.
authors: Mauro
authors: M
authors: Alves
authors: Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil.
authors: Nelson Albuquerque de
authors: NA
authors: Souza e Silva
authors: Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil.
authors: Lucia Helena Alvares
authors: LH
authors: Salis
authors: Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil.
authors: Basilio de Bragança
authors: Bde B
authors: Pereira
authors: Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil.
authors: Paulo Henrique
authors: PH
authors: Godoy
authors: Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil.
authors: Emília Matos do
authors: EM
authors: Nascimento
authors: Universidade Federal Fluminense, Niterói, RJ, Brazil.
authors: Jose Mario Franco
authors: JM
authors: Oliveira
mesh_terms: D000328:Adult; D000808:Angiotensinogen / Q000235:genetics*; D002318:Cardiovascular Diseases / Q000235:genetics / Q000401:mortality; D048909:Diabetes Complications; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D007676:Kidney Failure, Chronic / Q000235:genetics* / Q000401:mortality* / Q000628:therapy; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D007703:Peptidyl-Dipeptidase A / Q000235:genetics*; D011110:Polymorphism, Genetic / Q000235:genetics*; D006435:Renal Dialysis / Q000401:mortality*; D012084:Renin-Angiotensin System / Q000235:genetics*; D012307:Risk Factors; D013997:Time Factors
chemical_list: D000808:Angiotensinogen; D007703:Peptidyl-Dipeptidase A