title: Association Between Telomere Length, Chronic Kidney Disease, and Renal Traits: A Systematic Review.
abstract: Telomere length (TL) is an important biological variable that can influence a variety of disease-related complex traits as well as host-environment interactions such as drug and nutritional responses. Chronic kidney disease (CKD) is a common global health challenge especially with the currently aging world population. We conducted a PubMed database search according to the preferred reporting items for systematic reviews and meta-analysis (PRISMA) guidelines for systematic reviews. Studies in adults (18 years and above) in which TL was determined and correlated with CKD, renal traits, and function were included, while animal model studies were excluded. Nine studies comprising 7829 participants, published between 2005 and 2016, met the inclusion criteria. These included eight observational studies (six being prospective), and one clinical trial. Participants in two studies were diabetic patients with varying stages of CKD, and nondialysis chronic glomerulonephritis CKD patients in two other studies. TL measurements used polymerase chain reaction in five studies, terminal restriction fragmentation in three studies, and quantitative fluorescence in situ hybridization in one study. Short TL was independently associated with increased risk of prevalent microalbuminuria in diabetic men with CKD (p = 0.007). Among CKD patients with heterogeneous etiologies, however, there was an unadjusted lower risk (p < 0.001). Short TL was significantly associated with CKD progression among smokers (p = 0.001) and diabetic patients (p = 0.03). On the other hand, long TL was paradoxically associated with longer diagnosed duration of moderate CKD. We postulate that shortening TL might be associated with CKD prevalence/occurrence or declining kidney function, but this association is likely offset by the cellular telomere reparative process in those surviving longer with CKD. This systematic review underscores the need for future omics and human genetics research to delineate the contribution of TL to CKD, renal dysfunction, and related health outcomes. Telomeres and telomerase activity hold great promise for CKD risk stratification and personalized medicine.
authors.affiliation: 1 Zenith Medical and Kidney Centre , Abuja, Nigeria .
authors.forename: Oluwatoyin I
authors.initials: OI
authors.lastname: Ameh
authors.affiliation: 2 Division of Nephrology and Hypertension, Faculty of Health Sciences, University of Cape Town , Cape Town, South Africa .
authors.forename: Ikechi G
authors.initials: IG
authors.lastname: Okpechi
authors.affiliation: 3 Division of Human Genetics, Department of Pathology, Faculty of Health Sciences, Institute of Infectious Disease and Molecular Medicine, University of Cape Town , Cape Town, South Africa .
authors.forename: Collet
authors.initials: C
authors.lastname: Dandara
authors.affiliation: 4 Non-Communicable Diseases Research Unit, South African Medical Research Council, Cape Town , Cape Town, South Africa .
authors.forename: André-Pascal
authors.initials: AP
authors.lastname: Kengne
mesh_terms: D015415:Biomarkers / Q000378:metabolism*; D005921:Glomerulonephritis / Q000235:genetics; D006801:Humans; D007668:Kidney / Q000378:metabolism*; D051436:Renal Insufficiency, Chronic / Q000235:genetics*; D016615:Telomere / Q000235:genetics*
chemical_list: D015415:Biomarkers
keywords: Africa and genomics; biomarkers; chronic kidney disease; diagnostic medicine; gene regulation