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ACE Gene Polymorphism as a Prognostic Indicator in Patients With Type 2 Diabetes and Established Renal Disease

¹ Diabetes Clinic, St. Luke’s Hospital, Guardamangia, Malta
² Centre of Molecular Genetics, Institute of Clinical Science, University of Exeter, Exeter, U.K.

OBJECTIVE—To investigate whether the DD genotype is a predictor of mortality and of the decline in renal function in patients with type 2 diabetes and established nephropathy.

RESEARCH DESIGN AND METHODS—A total of 56 such patients of Maltese Caucasian descent were recruited, and their ACE genotype was determined. Serum creatinine was estimated approximately every 4 months. The glomerular filtration rate (GFR) was calculated according to the Cockroft-Gault formula, and rate of change was determined by regression analysis.

RESULTS—The rate of change in calculated GFR was -7.76 ml · min^–1 · year^–1 in those with the DD genotype (n = 31) and -1.17 ml · min^–1 · h^–1 in those with the ID or II genotype (n = 25) (P < 0.01). The 3-year mortality was 45.2% in the DD group compared with 20.0% in the ID/II group (P < 0.05).

CONCLUSIONS—The DD genotype of the ACE gene polymorphism is associated with a more rapid decline in renal function and higher mortality in type 2 diabetic patients with established nephropathy.

Abbreviations: GFR, glomerular filtration rate • LVH, left ventricular hypertrophy • PAI-1, plasminogen activator 1 • PCR, polymerase chain reaction

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