Evaluating the ACE I/D polymorphism identifies patients at risk for chronic kidney disease progression and those who may benefit most from renoprotective therapy with ACE inhibitors or ARAs.
Does evaluating the ACE I/D polymorphism help guide renoprotective therapy with ACE inhibitors or ARAs in patients with diabetic and nondiabetic nephropathies?
Evaluating the ACE I/D polymorphism may serve as a reliable tool to identify at-risk patients and personalize renoprotective therapy with ACE inhibitors or ARAs.
Despite the huge amount of studies looking for candidate genes, the ACE gene remains the unique, well-characterized locus clearly associated with pathogenesis and progression of chronic kidney disease, and with response to treatment with drugs that directly interfere with the renin angiotensin system (RAS), such as angiotensin converting enzyme (ACE) inhibitors and angiotensin II receptor antagonists (ARA). The II genotype is protective against development and progression of type I and type II nephropathy and is associated with a slower progression of nondiabetic proteinuric kidney disease. ACE inhibitors are particularly effective at the stage of normoalbuminuria or microalbuminuria in both type I and type II diabetics with the II genotype, whereas the DD genotype is associated with a better response to ARA therapy in overt nephropathy of type II diabetes and to ACE inhibitors in male patients with nondiabetic proteinuric nephropathies. The role of other RAS or non-RAS polymorphisms and their possible interactions with different ACE I/D genotypes are less clearly defined. Thus, evaluating the ACE I/D polymorphism is a reliable tool to identify patients at risk and those who may benefit the most of renoprotective therapy with ACE inhibitors or ARA. This may guide pharmacologic therapy in individual patients and help design clinical trials in progressive nephropathies. Moreover, it might help optimize prevention and intervention strategies at population levels, in particular, in countries where resources are extremely limited and 1 million patients continue to die every year of cardiovascular or renal disease.
Ruggenenti et al. (Fri,) conducted a review in Diabetic and nondiabetic nephropathies. ACE I/D polymorphism was evaluated. Evaluating the ACE I/D polymorphism identifies patients at risk for chronic kidney disease progression and those who may benefit most from renoprotective therapy with ACE inhibitors or ARAs.