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NDT Advance Access first published online on August 25, 2006
This version published online on September 2, 2006
Nephrology Dialysis Transplantation, doi:10.1093/ndt/gfl412
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© The Author [2006]. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org
Received April 21, 2006
Accepted June 14, 2006

Original Article

Influence of ACE I/D gene polymorphism in the progression of renal failure in autosomal dominant polycystic kidney disease: a meta-analysis

Tiago Veiga Pereira 1 *, Ane Cláudia Fernandes Nunes 2, Martina Rudnicki 3, Ricardo Magistroni 4, Alberto Albertazzi 4, Alexandre Costa Pereira 5, and José Eduardo Krieger 5

1 Department of Biochemistry and Molecular Biology, Federal University of São Paulo, São Paulo, São Paulo, Brazil
2 Medical Science and Nephrology Postgraduate Program, Federal University of Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
3 Clinical and Toxicological Analysis Department, Faculty of Pharmaceutical Sciences, University of São Paulo, São Paulo, São Paulo, Brazil
4 Division of Nephrology, Dialysis and Transplantation, University of Modena, Modena, Italy
5 Heart Institute (InCor), São Paulo University Medical School, University of São Paulo, São Paulo, São Paulo, Brazil

* To whom correspondence should be addressed.
Tiago Veiga Pereira, E-mail: t27026t{at}yahoo.com.br



  Abstract

Background. Autosomal dominant polycystic kidney disease (ADPKD) is a renal disease characterized by an important variability in clinical course, which cannot be fully explained by the genetic heterogeneity of the disease. Although the role for the angiotensin I-converting enzyme (ACE) insertion/deletion (I/D) polymorphism as a modifier factor in ADPKD renal deterioration has been suggested, direct evidence from genetic association studies remain inconclusive. To provide a more robust estimate of the putative effect of the ACE I/D polymorphism on the renal progression in ADPKD, we performed a meta-analysis pooling data from all relevant studies in which the role of the ACE I/D variant in ADPKD clinical features was evaluated.

Methods. We applied a random-effects model to combine odds ratio and 95% confidence intervals. Q-statistic was used to evaluate the homogeneity, and both Egger's and Begg-Mazumdar tests were used to assess publication bias.

Results. Altogether, three distinct meta-analyses were generated using data from 13 studies. Despite the absence of publication bias and the presence of homogeneity among study results, the DD genotype failed to show an influence on risk of end-stage renal disease (ESRD), mean age at ESRD or risk of hypertension in ADPKD patients when compared with I-allele carriers (DD vs ID + II). Likewise, meta-analyses carried out separately for Caucasian and Asian studies showed no indication of an association between the DD genotype and a faster renal deterioration in ADPKD.

Conclusion. These findings do not support the hypothesis that the enhanced ACE activity associated with the D allele might promote a significantly worse prognosis in patients with ADPKD.

Keywords: ACE gene polymorphism; ADPKD; progression of renal failure; meta-analysis; autosomal dominant polycystic kidney disease.

This version contains corrections from the author.


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