TY  - JOUR
A1  - Drechsler, Christiane
A1  - Meinitzer, Andreas
A1  - Pilz, Stefan
A1  - Krane, Vera
A1  - Tomaschitz, Andreas
A1  - Ritz, Eberhard
A1  - März, Winfried
A1  - Wanner, Christoph
T1  - Homoarginine, heart failure, and sudden cardiac death in haemodialysis patients
JF  - European Journal of Heart Failure
N2  - Aims

Sudden cardiac death (SCD) is a major contributor to the excess mortality of patients on maintenance dialysis. Homoarginine deficiency may lead to decreased nitric oxide availability and endothelial dysfunction. Based on this rationale we assessed whether homoarginine deficiency is a risk factor for SCD in dialysis patients.

Methods and results

This study examined the association of homoarginine with cardiovascular outcomes in 1255 diabetic haemodialysis patients from the German diabetes and dialysis study. During a median of 4 years of follow-up, hazard ratios (HR) (95% CI) for reaching the following pre-specified, adjudicated endpoints were determined: SCD, myocardial infarction, stroke, death due to heart failure, and combined cardiovascular events. There was a strong association of low homoarginine concentrations with the presence of congestive heart failure and left ventricular hypertrophy as well as increased levels of brain natriuretic peptide. Per unit decrease in homoarginine, the risk of SCD increased three-fold (HR 3.1, 95% CI 2.0–4.9), attenuating slightly in multivariate models (HR 2.4; 95% CI 1.5–3.9). Patients in the lowest homoarginine quintile experienced a more than two-fold increased risk of SCD, and more than three-fold increased risk of heart failure death than patients in the highest quintile, which accounted for the high incidence of combined cardiovascular events. Low homoarginine showed a trend towards increased risk of stroke, however, myocardial infarction was not meaningfully affected.

Conclusion

Low homoarginine is a strong risk factor for SCD and death due to heart failure in haemodialysis patients. Further studies are needed to elucidate the underlying mechanisms, offering the potential to develop new interventional strategies.
KW  - Homoarginine
KW  - Sudden cardiac death
KW  - Heart failure
KW  - Amino acids
KW  - Haemodialysis
Y1  - 2011
U6  - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-140495
VL  - 13
IS  - 8
ER  - 
TY  - JOUR
A1  - Carsten A., Böger
A1  - Gorski, Mathias
A1  - Li, Man
A1  - Hoffmann, Michael M.
A1  - Huang, Chunmei
A1  - Yang, Qiong
A1  - Teumer, Alexander
A1  - Krane, Vera
A1  - O'Seaghdha, Conall M.
A1  - Kutalik, Zoltán
A1  - Wichmann, H.-Erich
A1  - Haak, Thomas
A1  - Boes, Eva
A1  - Coassin, Stefan
A1  - Coresh, Josef
A1  - Kollerits, Barbara
A1  - Haun, Margot
A1  - Paulweber, Bernhard
A1  - Köttgen, Anna
A1  - Li, Guo
A1  - Shlipak, Michael G.
A1  - Powe, Neil
A1  - Hwang, Shih-Jen
A1  - Dehghan, Abbas
A1  - Rivadeneira, Fernando
A1  - Uitterlinden, André
A1  - Hofman, Albert
A1  - Beckmann, Jacques S.
A1  - Krämer, Bernhard K.
A1  - Witteman, Jacqueline
A1  - Bochud, Murielle
A1  - Siscovick, David
A1  - Rettig, Rainer
A1  - Kronenberg, Florian
A1  - Wanner, Christoph
A1  - Thadhani, Ravi I.
A1  - Heid, Iris M.
A1  - Fox, Caroline S.
A1  - Kao, W.H.
T1  - Association of eGFR-Related Loci Identified by GWAS with Incident CKD and ESRD
JF  - PLoS Genetics
N2  - Family studies suggest a genetic component to the etiology of chronic kidney disease (CKD) and end stage renal disease (ESRD). Previously, we identified 16 loci for eGFR in genome-wide association studies, but the associations of these single nucleotide polymorphisms (SNPs) for incident CKD or ESRD are unknown. We thus investigated the association of these loci with incident CKD in 26,308 individuals of European ancestry free of CKD at baseline drawn from eight population-based cohorts followed for a median of 7.2 years (including 2,122 incident CKD cases defined as eGFR < 60ml/min/1.73m(2) at follow-up) and with ESRD in four case-control studies in subjects of European ancestry (3,775 cases, 4,577 controls). SNPs at 11 of the 16 loci (UMOD, PRKAG2, ANXA9, DAB2, SHROOM3, DACH1, STC1, SLC34A1, ALMS1/NAT8, UBE2Q2, and GCKR) were associated with incident CKD; p-values ranged from p = 4.1e-9 in UMOD to p = 0.03 in GCKR. After adjusting for baseline eGFR, six of these loci remained significantly associated with incident CKD (UMOD, PRKAG2, ANXA9, DAB2, DACH1, and STC1). SNPs in UMOD (OR = 0.92, p = 0.04) and GCKR (OR = 0.93, p = 0.03) were nominally associated with ESRD. In summary, the majority of eGFR-related loci are either associated or show a strong trend towards association with incident CKD, but have modest associations with ESRD in individuals of European descent. Additional work is required to characterize the association of genetic determinants of CKD and ESRD at different stages of disease progression.
KW  - Chronic Kidney-disease
KW  - Stage renal-disease
KW  - Glomerular-filtration-rate
KW  - Diabetic-nephropathy
KW  - General-population
KW  - African-americans
KW  - Risk
KW  - Progression
KW  - Mortality
KW  - Variants
Y1  - 2011
U6  - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-133758
VL  - 7
IS  - 9
ER  -