Renin-angiotensin polymorphisms and QTc interval prolongation in end-stage renal disease

Raizada, Veena; Skipper, Betty J.; Luo, Wentao; Garza, Luis A.; Hines, Curt; Harford, Antonia; Zager, Philip G.; Griffith, Jeffrey K.; Raj, Dominic S.; Spalding, Charles T.

doi:10.1111/j.1523-1755.2005.00510.x

Cited by 27 publications

(28 citation statements)

References 29 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Previous reports have documented prolonged QT intervals among patients who have ESRD (5)(6)(7)(8). In contrast, a recent evaluation of nearly 200 nondialysis patients with earlier stages of CKD reported minimal association of kidney function with QT interval duration (8).…”

Section: Discussionmentioning

confidence: 96%

“…Disturbances of the cardiac electrical cycle might be detectable in early stages of CKD. Prolonged QT intervals and greater QT dispersion have been reported among uncontrolled case series of long-term hemodialysis patients (5)(6)(7). In contrast, a recent study found no association of kidney function with QT interval duration among approximately 200 nondialysis patients with earlier stages of CKD (8).…”

mentioning

confidence: 99%

See 1 more Smart Citation

Kidney Function, Electrocardiographic Findings, and Cardiovascular Events among Older Adults

Kestenbaum¹,

Rudser²,

Shlipak³

et al. 2007

Clinical Journal of the American Society of Nephrology

View full text Add to dashboard Cite

Chronic kidney disease (CKD) is associated with cardiovascular (CV) disease and mortality. It is not known whether cardiac rhythm disturbances are more prevalent among individuals with CKD or whether resting electrocardiogram findings predict future CV events in the CKD setting. Data were obtained from the Cardiovascular Health Study, a community-based study of adults aged >65 yr. After exclusions for prevalent heart disease, atrial fibrillation, implantable pacemaker, or antiarrhythmic medication use, 3238 participants were analyzed. CKD was defined by an estimated GFR <60 ml/min per 1.73 m 2 . Outcomes were adjudicated incident heart failure (HF), incident coronary heart disease (CHD), and mortality. Participants with CKD had longer PR and corrected QT intervals compared with those without CKD; however, differences in electrocardiographic markers were explained by traditional CV risk factors and CV medication use. After adjustment for known risk factors, each 10-ms increase in the QRS interval was associated with a 15% greater risk for incident HF (95% confidence interval [CI] 1.04 to 1.27), a 13% greater risk for CHD (95% CI 1.04 to 1.24), and a 17% greater risk for mortality (95% CI 1.09, 1.25) among CKD participants. Each 5% increase in QTI was associated with a 42% (95% CI 1.23 to 1.65), 22% (95% CI 1.07 to 1.40), and 10% (95% CI 0.98 to 1.22) greater risk for HF, CHD, and mortality, respectively. Associations seemed stronger for participants with CKD; however, no significant interactions were detected. Resting electrocardiographic abnormalities are common in CKD and independently predict future clinical CV events in this setting.

show abstract

Section: Discussionmentioning

confidence: 96%

mentioning

confidence: 99%

Kidney Function, Electrocardiographic Findings, and Cardiovascular Events among Older Adults

Kestenbaum¹,

Rudser²,

Shlipak³

et al. 2007

Clinical Journal of the American Society of Nephrology

View full text Add to dashboard Cite

show abstract

“…Thus, the concept of using ECG indices of ventricular repolarization to assess the arrhythmogenic risk of individual patients remains an important research objective [51] . It is generally accepted that a HD session induces prolongation of QT interval parameters, and Raizada et al [52] showed an association of QT interval parameters with renin-angiotensin system polymorphisms.…”

Section: Discussionmentioning

confidence: 99%

Cardiac Vascular Calcification and QT Interval in ESRD Patients: Is There a Link?

Iorio

Bortone²,

Piscopo³

et al. 2006

Blood Purif

View full text Add to dashboard Cite

We will present our experience and our preliminary data about the correlation between cardiac calcification and QT interval (and QT dispersion) in uraemia. We studied 32 haemodialysis (HD) patients (age 69 ± 16 years, time on dialysis 32 ± 27 months) and 12 chronic kidney disease stage 4 (CKD-4) patients (age 66 ± 17 years, uraemia duration 38 ± 16 months). The patients were characterized by a good mineral control, as shown by serum phosphate levels (3.6 ± 1.3 mg/dl in CKD-4 and 4.3 ± 1.6 mg/dl in HD patients) and Ca × P product (46 ± 17 and 49 ± 16 mg²/dl², respectively). The parathyroid hormone levels were higher in HD than CKD-4 patients (p < 0.0001). A TC score >400 was found to be highly prevalent in both groups. Significantly more HD patients (62.5%) showed cardiac calcification than CKD-4 patients (33%; p = 0.01). The patients were matched for TC scores higher or lower than 400. The two groups differed by gender (p < 0.05), age (p = 0.026), frequency of diabetes mellitus (p < 0.01), uraemia follow-up period (p < 0.001), low-density lipoprotein cholesterol level (p = 0.009), Ca × P product (p = 0.002), parathyroid hormone level (p < 0.0001), and corrected QT dispersion (p < 0.0001). The QT interval was higher in HD and CKD-4 patients with higher TC scores (approximately 11%), but QT interval dispersion was significantly higher in patients with TC scores >400. QT dispersion showed a linear correlation with TC scores in both groups (r = 0.899 and p < 0.0001 and r = 0.901 and p < 0.0001). Male gender, age, time (months) of uraemia, low-density lipoprotein cholesterol, albumin, calcium × phosphorus product, parathyroid hormone, and TC score are important determinants of QT dispersion. Our data show that it is possible to link dysrhythmias and cardiac calcification in uraemic patients.

show abstract

“…34 Recently, Raizada et al reported no association of AGT M235T polymorphism with QT parameters among patients with end stage renal disease, based on a cross-sectional study. 35 Although the T allele has been reported to be associated with cardiac structural change and atrial arrhythmia in Chinese, we did not find a link between QT parameters and AGT M235T polymorphism. In addition, the effect of AGT M235T polymorphism on cardiac AGT concentration is unclear, despite its association with plasma AGT levels.…”

Section: Discussionmentioning

confidence: 35%

D-Allele of ACE Polymorphism is Associated With Increased Magnitude of QT Dispersion Prolongation in Elderly Chinese 4-Year Follow-up Study

Lin

Chiu

et al. 2007

Circ J

View full text Add to dashboard Cite

he frequency of arrhythmia increases with age, probably because of age-associated degenerative changes in the conduction system, as well as myocardial fibrosis. 1 Ventricular repolarization abnormality plays an important role in the occurrence of arrhythmia. The QT interval and QT dispersion (QTd), 2 of the repolarization parameters, are prolonged with increasing age, which may contribute to an increased risk of ventricular arrhythmias and cardiac mortality in elderly patients. 2 Several large prospective studies have assessed the predictive value of QTd and corrected QT interval (QTc) dispersion (QTcd) for cardiac and all-cause mortality, 3,4 and their results suggest that long QTd and QTcd are associated with cardiovascular morbidity and mortality. More recently, transmural dispersion of repolarization (TDR) has been evaluated by measuring the interval between the peak and the end of the T wave (Tpe), as well as the Tpe interval divided by the QT interval (Tpe/QT) ratio, creating 2 new repolarization parameters. 5,6 These increased TDR-related parameters were Circulation Journal Vol. 71, January 2007 found to be associated with the occurrence of arrhythmias, such as torsades de pointes in long QT syndrome. 6 Furthermore, a cross-sectional study showed that TDR parameters increased with age. 7 Therefore, it is mandatory to determine the risk factors in the elderly that may predispose to prolongation of these repolarization parameters.The renin -angiotensin system (RAS) is involved in many cardiovascular diseases. Carriers of the D-allele of angiotensin-converting enzyme (ACE) insertion/deletion (I/D) polymorphism display elevated serum and cardiac ACE activity and thus may have higher RAS system activation. 8,9 Therefore, the D-allele carriers are exposed to a higher level of angiotensin II than non-D allele carriers. Compelling studies report that the ACE D-allele is associated with myocardial infarction, sudden death and malignant ventricular arrhythmia. [10][11][12] Furthermore, the D-allele has been associated with QTd in hypertensive subjects or survivors of myocardial infarction. 13,14 Angiotensinogen (AGT) M235T polymorphism is associated with plasma AGT levels that increase stepwise according to the number of T alleles present. 15 The T allele has very different distributions in Asians (70-73%) and Caucasians (10-24%). 16,17 One study showed that homozygosity for the T allele was associated with increased risk of cardiovascular diseases, such as hypertension, coronary artery disease and myocardial infarction. 15 To our knowledge, the influence of gene polymorphisms on QTd and TDR-related parameters has not been reported in a prospective cohort. We therefore conducted a prospective study to investigate several physiological parameters

show abstract

Renin-angiotensin polymorphisms and QTc interval prolongation in end-stage renal disease

Abstract: Polymorphisms of ACE and AT1R genes additively contribute to QTc prolongation found in a great majority of ESRD patients. Therefore, ESRD patients with both or one of these polymorphisms may be at a higher risk for sudden cardiac death.

Cited by 27 publications

References 29 publications

Kidney Function, Electrocardiographic Findings, and Cardiovascular Events among Older Adults

Kidney Function, Electrocardiographic Findings, and Cardiovascular Events among Older Adults

Cardiac Vascular Calcification and QT Interval in ESRD Patients: Is There a Link?

D-Allele of ACE Polymorphism is Associated With Increased Magnitude of QT Dispersion Prolongation in Elderly Chinese 4-Year Follow-up Study

Contact Info

Product

Resources

About