Asociación del polimorfismo rs5186 del gen AGTR1 con disminución de la TFGe en pacientes con diabetes tipo 2 de la Ciudad de México / Association of the rs5186 polymorphism of the AGTR1 gene with decreased eGFR in patients with type 2 diabetes from Mexico City

Antecedentes: La búsqueda de biomarcadores tempranos de enfermedad renal diabética (ERD) en pacientes con diabetes mellitus tipo 2 (DMT2), como los marcadores genéticos para identificar pacientes vulnerables de la enfermedad, incluso antes de la presencia de una disminución de la estimación de tasa de filtrado glomerular (TFGe) o presencia de microalbuminuria ha cobrado importancia en los últimos años. El polimorfismo rs5186 (A1166C) presente en el gen receptor tipo 1 de la angiotensina II (AGTR1) ha sido asociado a distintos efectos del riesgo de daño renal que suelen estar presentes en pacientes con diabetes mellitus (DM). Se ha descrito que el rs5186 podría influir en la estabilidad de las proteínas que conforman al receptor de la angiotensina II tipo 1 (AT1) alterando su actividad, por lo que podría ser considerado como un factor de riesgo a enfermedad renal crónica (ERC) caracterizada por una disminución progresiva de la TFG. Sin embargo, la asociación del polimorfismo rs5186 del gen AGTR1 con ERD en pacientes con DMT2 ha sido controversial, no concluyente, incluso nula. Las controversias podrían ser por los estudios de asociación y estimación del riesgo del rs5186 previamente reportados incluyen distintos fenotipos clínicos considerados como inductores y potenciadores de ERC, además, los tamaños de las muestras analizadas en pacientes con DMT2 eran pequeñas y no tenían un control estricto en su inclusión, careciendo incluso de marcadores bioquímicos o estadificación KDOQI que han dificultado su análisis. Objetivo: Determinar la asociación del rs5186 del gen AGTR1 con la disminución de TFGe considerada como riesgo al desarrollo de ERD en pacientes con DMT2.(AU)

Background: Early biomarkers search for Diabetic Kidney Disease (DKD) in patients with Type 2 Diabetes Mellitus (T2DM), as genetic markers to identify vulnerable carriers of the disease even before Glomerular Filtration Rate (GFR) decline or microalbuminuria development, has been relevant during the last few years. The rs5186 (A116C) polymorphism of the Angiotensin II Receptor Type I gene (AGTR1), has been associated to multiple effects of renal injury risk, commonly detected in patients with Diabetes Mellitus (DM). It has been described that rs5186 could have an effect in stability proteins that assemble Angiotensin II Receptor Type I (AT1), modifying its action, which is why it should be considered as a risk factor for Chronic Kidney Disease (CKD), characterized by a GFR progressive reduction. Even though, the association between rs5186 AGTR1 gene polymorphism and DKD in patients with T2DM has been controversial, inconclusive, and even absent. This disputable issue might be as a result of association studies in which many and varied clinical phenotypes included are contemplated as CKD inductors and enhancers. Although, the sample sizes studied in patients with T2DM are undersized and did not have a strict inclusion criteria, lacking of biochemical markers or KDOQI classification, which have hindered its examination.Objective: The aim of our study was to establish an association between rs5186 AGTR1 gene polymorphism and GFR depletion, assessed as a risk factor to DKD development in patients with T2DM. (AU)

Evolution of the stage of chronic kidney disease from the diagnosis of hypertension in primary care / Evolución del estadio de la enfermedad renal crónica desde el diagnóstico de hipertensión arterial en atención primaria

Objective: To analyze the evolution of the stages of CKD and the progression of the estimation of glomerular filtration rate (eGFR) in patients with newly diagnosed hypertension. Design-: Retrospective cohort.SiteFamily Medicine Unit No. 31, Mexican Social Security Institute, Mexico City. Participants: Patients with hypertension who have been diagnosed in primary care and have developed chronic kidney disease .Main measurements: The eGFR was calculated with the CKD Epi formula in three moments, the first measurement was at the time of diagnosis of hypertension, the second measurement was made when it arrived a change in CKD stage and the last one at the end of the study, with which the evolution time from one stage to another was obtained, as well as the drop in eGFR. Results: The sample consisted of 207 electronic health records of patients, with an average follow-up of 10.2 years from the moment of diagnosis of hypertension until the end of the study. The average time to go from one baseline stage of CKD to another was 7 years (average decline in eGFR of 5.8ml/min/year) and to have a second stage change was 3.2 years (average decline in eGFR of 6.8ml/min/year), with a statistically significant repeated measures ANOVA (p<0.001). Conclusions: Patients with newly diagnosed hypertension remain longer in the initial stages of CKD, to later evolve and change more quickly.(AU)

Objetivo: Analizar la evolución de los estadios de la enfermedad renal crónica (ERC) y la progresión de la estimación de la tasa de filtración glomerular (eTFG) en pacientes con hipertensión arterial de nuevo diagnóstico. Diseño: Cohorte retrospectiva. Emplazamiento: Unidad de Medicina Familiar N.° 31, Instituto Mexicano del Seguro Social, Ciudad de México. Participantes: Pacientes hipertensos que hayan sido diagnosticados en atención primaria y hayan desarrollado ERC. Mediciones principales: La eTFG se calculó con la fórmula CKD Epi en 3 momentos. La primera medición fue al momento del diagnóstico de hipertensión arterial, la segunda medición se realizó cuando se presentó un cambio de estadio de la ERC y la última, al final del estudio, con el que se obtuvo el tiempo de evolución de un estadio a otro, así como el descenso de la eTFG. Resultados: La muestra estuvo constituida por 207 historias clínicas electrónicas de pacientes, con un seguimiento promedio de 10,2 años desde el momento del diagnóstico de hipertensión arterial hasta el final del estudio. El tiempo promedio para pasar de una etapa inicial de la ERC a otra fue de 7 años (disminución promedio de la eTFG de 5,8ml/min/año) y para tener un cambio de segunda etapa fue de 3,2 años (disminución promedio de la eTFG de 6,8ml/min/año), con un ANOVA de medidas repetidas estadísticamente significativo (p < 0,001). Conclusiones: Los pacientes con hipertensión arterial de nuevo diagnóstico permanecen más tiempo en los estadios iniciales de la ERC, para luego evolucionar y cambiar más rápidamente.(AU)

Evolution of the stage of chronic kidney disease from the diagnosis of hypertension in primary care.

OBJECTIVE: To analyze the evolution of the stages of CKD and the progression of the estimation of glomerular filtration rate (eGFR) in patients with newly diagnosed hypertension. DESIGN: Retrospective cohort. SITE: Family Medicine Unit No. 31, Mexican Social Security Institute, Mexico City. PARTICIPANTS: Patients with hypertension who have been diagnosed in primary care and have developed chronic kidney disease. MAIN MEASUREMENTS: The eGFR was calculated with the CKD Epi formula in three moments, the first measurement was at the time of diagnosis of hypertension, the second measurement was made when it arrived a change in CKD stage and the last one at the end of the study, with which the evolution time from one stage to another was obtained, as well as the drop in eGFR. RESULTS: The sample consisted of 207 electronic health records of patients, with an average follow-up of 10.2 years from the moment of diagnosis of hypertension until the end of the study. The average time to go from one baseline stage of CKD to another was 7 years (average decline in eGFR of 5.8ml/min/year) and to have a second stage change was 3.2 years (average decline in eGFR of 6.8ml/min/year), with a statistically significant repeated measures ANOVA (p<0.001). CONCLUSIONS: Patients with newly diagnosed hypertension remain longer in the initial stages of CKD, to later evolve and change more quickly.