遗传会增加透析患者的心脏停止风险


  【24drs.com】根据在线发表于4月16日美国肾脏学会期刊的一篇研究,遗传因素是造成透析患者心脏停止的风险因素。
  
  麻州波士顿麻州综合医院、Fresenius Medical Care North America的Kevin Chan医师写道,发现[末期肾病患者]的心脏停止预测标记可以改变肾脏科实务,因为透析患者每年的心脏停止风险达到5%。
  
  他们发现,没有住在一起的遗传相关家庭成员,有接受透析者的心脏停止风险,比表型匹配但无亲属关系、同样接受透析的对照组高88% (胜算比[OR],1.88;95%信赖区间[95% CI],1.25 - 2.84)。
  
  整体而言,研究者发现,这个世代研究中,亲属组死于心脏停止者为4.3%,对照组为2.6%,他们计算发现,住在一起的遗传相关家属,心脏停止风险比没亲属关系的透析患者高66%(OR,1.66;95% CI,1.20 - 2.28)。
  
  相对的,配偶接受透析,属于住在相同环境但是遗传上无关,心脏停止风险没有增加(OR,0.95;95% CI,0.60 - 1.59)。
  
  Chen医师等人写道,整体来看,我们的研究认为,对于透析患者,家族史显著增加了致命的心脏停止风险达近70%,而同居或分居的家庭成员的风险则没有大变化。
  
  研究团队检视了5,117组病患,与长期透析机构的650,000名末期肾病患者来自相同家庭;其中4,053对是遗传上相关,后续分成住在一起(n =2449)或没有住在一起(n = 1604),其余1,064对则是没有遗传关系的配偶。
  
  使用多变项逻辑模式确认遗传的影响程度以及心脏停止相关的后天因素。
  
  研究显示,相较于没有心脏停止家族史者,非配偶的亲戚曾死于心脏停止者,则患者死于心脏停止风险增加45%(OR,1.45;95% CI,1.19 - 1.75)。
  
  与心脏停止风险增加有关的其它重要因素,包括年龄、黑人、血清钾浓度、红血球生成素剂量、曾发生冠状动脉疾病;与心脏停止风险较低有关的保护因子,包括较高的白蛋白值以及低钙透析液浴。
  
  Chan医师在新闻稿中表示,这些研究结果认为遗传因素—或DNA序列尚的差异—造成透析患者的猝逝风险较高;未来需要更多有关透析族群的遗传研究,以厘清可以用来解释心脏停止高风险的特定基因,并为这些患者找到新疗法。
  
  接受透析次数20次以上的病患可能比一般人更容易发生心脏停止。
  
  资料来源:http://www.24drs.com/
  
  Native link:Genetics Ups Risk of Cardiac Arrest in Dialysis Patients

Genetics Ups Risk of Cardiac Arrest in Dialysis Patients

By Pam Harrison
Medscape Medical News

Heritable factors appear to contribute to the risk for cardiac arrest in patients receiving dialysis, according to a study published online April 16 in the Journal of the American Society of Nephrology.

"The discovery of predictive markers for cardiac arrest in [end-stage renal disease] could alter the practice of nephrology, because the risk of cardiac arrest is 5% per year in the dialysis population," write Kevin Chan, MD, from Fresenius Medical Care North America, Massachusetts General Hospital, Boston, Massachusetts, and colleagues.

They found that genetically related family members receiving dialysis who were not living together had an 88% greater risk for cardiac arrest (odds ratio [OR], 1.88; 95% confidence interval [95% CI], 1.25 - 2.84) compared with phenotypically matched unrelated control patients who were also receiving dialysis.

Overall, the investigators found that 4.3% of both members of family pairs involved in the cohort study died of cardiac arrest compared with 2.6% of control pairs. They calculated that genetically related family members who lived together had a 66% greater risk for cardiac arrest compared with dialysis patients who were not related (OR, 1.66; 95% CI, 1.20 - 2.28).

In contrast, spouses receiving dialysis, who lived together in the same environment but who were unrelated genetically, had no increase in risk for cardiac arrest (OR, 0.95; 95% CI, 0.60 - 1.59).

"Taken altogether, our study suggests that family history significantly increased the risk of fatal cardiac arrest by approximately 70% among patients on dialysis," Dr Chen and colleagues write. "[A]nd we did not see a large change in risk among family members who cohabited or lived apart."

The team identified 5117 pairs of patients who came from the same family among a population of close to 650,000 patients with end-stage renal disease drawn from chronic dialysis facilities.

Some 4053 of these pairs were genetically related and were further classified into pairs who lived together (n = 2449) and pairs who lived in separate environments (n = 1604).

Another 1064 of these pairs were non–genetically related spouses.

Multivariable logistic modelling was used to determine the effect size of inherited and acquired factors associated with cardiac arrests.

Results showed that patients with a nonspouse relative who had previously died from a cardiac arrest had a 45% increased risk of dying from a cardiac arrest relative to patients without a family history of cardiac arrest (OR, 1.45; 95% CI, 1.19 - 1.75).

Other significant factors associated with an increased risk for cardiac arrest included age, black race, serum potassium levels, erythropoietin doses, and documented coronary artery disease.

Protective factors associated with a lower risk for cardiac arrest included higher albumin levels and a lower calcium dialysate bath.

"These findings...suggest that genetic factors — or differences in DNA sequence — contribute to the high risk of sudden death among patients on dialysis," Dr Chan said in a news release. "It paves the way for more detailed genetic studies in the dialysis population to find specific genes that could explain the high risk of cardiac arrest and potentially new treatments for these patients."

Patients receiving dialysis are 20 times more likely to have a cardiac arrest compared with the general population.

Dr Chen and one coauthor receive salary support from Fresenius Medicare North America. The other authors have disclosed no relevant financial relationships.

J Am Soc Nephrol. Published online April 16, 2015.

    
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