Survival in type 2 diabetic patients in dialysis and the number of risk alleles in polymorphisms of the renin-angiotensin system genes

ObjectivesTo study the combined effect of polymorphisms in genes of the renin-angiotensin system on mortality in type 2 diabetic patients in dialysis.Design and methodsFrom 1993 to 2007, we followed 89 patients from the start of dialysis until the end point, which was all-cause mortality. All patients were genotyped for the following polymorphisms: ACE (I/D), AGT (p.235M>T) and AGTR1 (g.1166A>C). The relative risks of death were examined by Cox-proportional hazard analysis after adjusting for age, sex, modality of dialysis, baseline and residual filtration rate, cardiovascular comorbidity, anemia, glycemic control, hypertension, nutritional status, risk of infection and dyslipidemia.ResultsWe first assigned and quantified the number of risk alleles – D (I/D), M (p.235 M>T) and A (g.1166A>C) – each patient carried. The Cox-proportional hazard analysis showed that every single additional risk allele multiplied the mortality hazard ratio by 1.58 (95% CI: 1.16–2.15, P = 0.003).ConclusionsOur data suggest a combined effect among the polymorphisms of the Renin-Angiotensin-System genes on mortality in type 2 diabetic patients undergoing dialysis.