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January 31, 2014PLoS ONEOpen Access

Angiotensin-Converting Enzyme Insertion/Deletion Polymorphism Contributes High Risk for Chronic Kidney Disease in Asian Male with Hypertension–A Meta-Regression Analysis of 98 Observational Studies

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Key result

The D allele of the ACE gene was associated with an increased risk of chronic kidney disease compared to the I allele (OR 1.21), with the highest risk observed in hypertensive Asian males (OR 3.75).

Why the study?

Does carrying the D allele of the ACE gene increase the risk of chronic kidney disease in Asian and Caucasian adults?

Population

Adults >18 years of Asian or Caucasian ethnicity without rare diseases, from 98 observational studies…

Comparison

Carrying the D allele of the… vs Carrying the I allele of the ACE gene

Design

Meta-analysis

Authors

CLChin LinTri-Service General HospitalHYHsin‐Yi YangFu Jen Catholic UniversityCWChia‐Chao WuNational Defense University

Discussion

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Implication

Supports targeted CKD risk assessment in hypertensive Asian males; leaves open prospective validation before clinical adoption.

Study Design

Type

Meta-Analysis

Structured PICO

Does carrying the D allele of the ACE gene increase the risk of chronic kidney disease in Asian and Caucasian adults?

P
Population
A meta-analysis of 98 observational studies including adults over 18 years of age of Asian or Caucasian ethnicity to evaluate the association between ACE I/D polymorphisms and chronic kidney disease.
E
Exposure
Carrying the D allele of the angiotensin-converting enzyme (ACE) gene insertion/deletion (I/D) polymorphism
C
Comparator
Carrying the I allele of the ACE gene
O
Outcome
Risk of chronic kidney disease (CKD)hard clinical

Main Result

Odds Ratio: 1.21 (95% CI 1.13–1.29)

The ACE I/D polymorphism D allele is associated with a significantly increased risk of chronic kidney disease, particularly in hypertensive Asian males.

Limitations

  • Relied on tabular data rather than individual patient data, possibly leading to an inflated standard error in pooled analyses
  • Estimates of diabetes mellitus and hypertension prevalence did not factor in the effects of therapy for them
  • May have missed unpublished data for the nondiabetic nephropathy subgroup
  • Estimating moderate effects is difficult in meta-analysis using case-control studies
  • Previous studies seldom reported stratified or matching data

Cite This Study

Lin et al. (2014) conducted a meta-analysis in Chronic Kidney Disease. ACE I/D polymorphism (D allele) vs. I allele was evaluated on All-cause CKD risk (OR 1.21, 95% CI 1.13-1.29). The D allele of the ACE gene was associated with an increased risk of chronic kidney disease compared to the I allele (OR 1.21), with the highest risk observed in hypertensive Asian males (OR 3.75).

synapsesocial.com/papers/6a1ff64ac1b320180d0db30ahttps://doi.org/10.1371/journal.pone.0087604

Topics

Hypertension management
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1Meta‐analysis of the relationship between ACE I/D gene polymorphism and end‐stage renal disease in patients with diabetic nephropathy2012 · 64 citations
  2. 2Null association between ACE gene I/D polymorphism and diabetic nephropathy among multiethnic Malaysian subjects2010 · 47 citations
  3. 3The insertion/deletion polymorphism of the angiotensin-converting enzyme gene is associated with progression, but not development, of albuminuria in Iranian patients with type 2 diabetes2009 · 23 citations
  4. 4Prognostic Value of Angiotensin-I Converting Enzyme I/D Polymorphism for Nephropathy in Type 1 Diabetes Mellitus2001 · 120 citations
  5. 5THE DD GENOTYPE OF THE ACE GENE POLYMORPHISM IS ASSOCIATED WITH DIABETIC NEPHROPATHY IN TYPE-1 DIABETICS2001 · 20 citations