The D Allele of Angiotensin‐Converting Enzyme Polymorphism as a Predictor of Renal Function Decline over 4 Years in an Apparently Healthy Chinese Population Aged 60 and Older

OBJECTIVES: To test the association between angiotensin-converting enzyme (ACE) insertion or deletion (I/D) polymorphism and decline of renal function in people aged 60 and older. DESIGN: Population-based prospective study with 4-year follow-up. SETTING: Department of Internal Medicine and Family Medicine, Kaohsiung Medical University (KMU) Hospital and Graduate Institute of Medicine and Public Health, KMU. PARTICIPANTS: Of 1,500 people screened, 193 subjects were enrolled, and 144 completed 4 years of follow-up, 112 non-diabetic normotensive elderly people were analyzed. MEASUREMENTS: Subjects received biochemistry examination at baseline and at 2- and 4-year follow-ups. Serum creatinine and calculated renal parameters, including the Cockroft-Gault (CG) formula, the Jelliffe formula, and the Modification of Diet in Renal Disease (MDRD) Study equation, were used. Genetic polymorphism was analyzed according to the polymerase chain reaction. RESULTS: The mean age+/-standard deviation of the subjects was 71.9+/-3.7 (range 60-81). Serum creatinine, CG creatinine clearance (CrCl), Jelliffe CrCl, and MDRD glomerular filtration rate (GFR) were significantly lower at the 2- and 4-year follow-ups (all P < or = .001). At the 4-year follow-up, the magnitude of declines of the above four renal parameters was significantly higher in subjects with the ACE D allele than in the non-D-allele carriers (P = .01, .01, .04, and .01 for creatinine, CG CrCl, Jelliffe CrCl, and MDRD GFR, respectively). This association was still significant in multivariate analyses (P < or = .02 for all parameters). CONCLUSION: This longitudinal study showed the ACE I/D gene polymorphism might modulate renal function decline in elderly Chinese. This provides further knowledge essential in the assessment of renal disease and determination of renal function in older Chinese.