Association of Candidate Gene Polymorphisms With Chronic Kidney Disease: Results of a Case-Control Analysis in the Nefrona Cohort

Chronic kidney disease (CKD) is a major risk factor for end-stage renal disease, cardiovascular disease and premature death. Despite classical clinical risk factors for CKD and some genetic risk factors have been identified, the residual risk observed in prediction models is still high. Therefore, new risk factors need to be identified in order to better predict the risk of CKD in the population. Here, we analyzed the genetic association of 79 SNPs of proteins associated with mineral metabolism disturbances with CKD in a cohort that includes 2, 445 CKD cases and 559 controls. Genotyping was performed with matrix assisted laser desorption ionizationtime of flight mass spectrometry. We used logistic regression models considering different genetic inheritance models to assess the association of the SNPs with the prevalence of CKD, adjusting for known risk factors. Eight SNPs (rs1126616, rs35068180, rs2238135, rs1800247, rs385564, rs4236, rs2248359, and rs1564858) were associated with CKD even after adjusting by sex, age and race. A model containing five of these SNPs (rs1126616, rs35068180, rs1800247, rs4236, and rs2248359), diabetes and hypertension showed better performance than models considering only clinical risk factors, significantly increasing the area under the curve of the model without polymorphisms. Furthermore, one of the SNPs (the rs2248359) showed an interaction with hypertension, being the risk genotype affecting only hypertensive patients. We conclude that 5 SNPs related to proteins implicated in mineral metabolism disturbances (Osteopontin, osteocalcin, matrix gla protein, matrix metalloprotease 3 and 24 hydroxylase) are associated to an increased risk of suffering CKD

Aspectos nutricionales en diálisis

Los pacientes con IRC presentan frecuentemente desnutrición, fundamentalmente una vez iniciada la diálisis, al añadirse factores propios de la técnica dialítica a los previamente existentes. La desnutrición conlleva un mayor riesgo de morbi-mortalidad global y fundamentalmente cardiovascular. Factos como la calidad de diálisis, la pérdida de nutrientes y más recientemente la existencia de una reacción inflamatoria crónica subyacente (bioincompatibilidad), contribuyen al desarrollo de desnutrición. Es preciso una intervención nutricional precoz y proporcional a la situación individual del paciente.Giltzurruneko gutxiegitasun kronikoa duten gaixoek askotan desnutrizioa jasan ohi dute, batez ere dialisia hasi ondoren, jadanik aurretik bazeuden faktoreei dialisi teknikari dagozkionak gehitzen zaizkielako. Desnutrizioak morbilitate-heriotza arrisku orokor handiagoa dakar, funtsean kardiobaskular motakoa. Dialisiaren kalitatea, elikagaien galera eta, berrikiago, azpian dagoen hantura erreakzio kronikoa (biobateragaiztasuna) bezalako faktoreek desnutrizioa garatzen laguntzen dute. Beharrezkoa da nutrizio interbentzio goiztiarra eta gaixo bakoitzaren egoeraren araberakoa.Les patients avec IRC souffrent fréquemment de malnutrition, fondamentalement parce qu'une fois la dialyse commencée, des facteurs propres à la technique dialytique s'ajoutent à ceux qui existaient auparavant. Des faits tels que la qualité de la dialyse, la perte de substances nutritives et plus récemment l'existence d'une réaction inflammatoire chronique sous-jacente (bioincompatibilité), contribuent au développement de la malnutrition. Une intervention nutritive précoce et proportionnelle à la situation individuelle du patient est nécessaire.Patients with chronic kidney insufficiency usually suffer malnutrition, fundamentally once the dialysis has been initiated, as factors pertaining to the dialysis technique are added to other previously existing factors. Malnutrition implies a higher risk of global morbidity-mortality, fundamentally of a cardiovascular character. Factors such as the quality of the dialysis, the loss of nutrients and more recently the existence of a chronic underlying inflammatory reaction (bio-incompatibility), contribute to the development of malnutrition. An early nutritional intervention that is proportional to the patient's individual situation becomes necessar