ACE gene polymorphism, left ventricular geometry, and mortality in diabetic patients with end-stage renal disease

Sakka, Yumiko; Babazono, Tetsuya; Sato, Asako; Ujihara, Noriko; Iwamoto, Yasuhiko

doi:10.1016/j.diabres.2003.10.010

« Previous Next »Diabetes Research and Clinical Practice
Volume 64, Issue 1 , Pages 41-49, April 2004

ACE gene polymorphism, left ventricular geometry, and mortality in diabetic patients with end-stage renal disease

Yumiko Sakka
- Division of Nephrology and Hypertension, Diabetes Center, Tokyo Women’s Medical University School of Medicine, 8-1 Kawadacho, Shinjukuku, Tokyo 162-8666, Japan
Tetsuya Babazono
- Division of Nephrology and Hypertension, Diabetes Center, Tokyo Women’s Medical University School of Medicine, 8-1 Kawadacho, Shinjukuku, Tokyo 162-8666, Japan
- Corresponding author. Tel.: +81-3-3353-8111; fax: +81-3-3358-1941.
Asako Sato
- Department of Medicine, Diabetes Center, Institute of Geriatrics, Tokyo Women’s Medical University School of Medicine, Tokyo, Japan
Noriko Ujihara
- Department of Medicine, Institute of Geriatrics, Tokyo Women’s Medical University School of Medicine, Tokyo, Japan
Yasuhiko Iwamoto
- Department of Medicine, Diabetes Center, Institute of Geriatrics, Tokyo Women’s Medical University School of Medicine, Tokyo, Japan

Received 16 June 2003; received in revised form 18 September 2003; accepted 7 October 2003.

Abstract

The objectives of this study were to determine the association between angiotensin converting enzyme (ACE) gene polymorphism and left ventricular (LV) geometry, and to clarify independent effects of ACE genotype on mortality after commencing dialysis in diabetic patients with end-stage renal disease (ESRD). A total of 106 diabetic patients, 71 men and 35 women, 11 type 1 and 95 type 2 diabetic, 57±12 () years of age, who started dialysis were studied. Patients with cardiac diseases and those treated with ACE inhibitors were excluded because of potential effects on LV performance. Echocardiographic examination was performed within ±2 months of the start of dialysis. Relation between ACE genotype and LV mass index (LVMI) or relative wall thickness (RWT) at onset of dialysis, and impact of ACE genotype on survival after commencing dialysis were evaluated. There were no significant differences in LVMI or RWT in the three ACE genotype groups at onset of dialysis. However, mortality of patients with the ACE–DD genotype was significantly higher than patients with the DI and II genotypes (hazard ratio, 2.318; P=0.043), based on a survival analysis with a mean follow-up duration of 60 months. The higher mortality in patients with the DD genotype was confirmed to be independent of LV hypertrophy and increases in RWT. In diabetic patients with ESRD, ACE genotype has no association with LV mass or RWT at the start of dialysis, but does have an independent impact on patient survival thereafter.