遺傳會增加透析患者的心臟停止風險


  【24drs.com】根據線上發表於4月16日美國腎臟學會期刊的一篇研究,遺傳因素是造成透析患者心臟停止的風險因素。
  
  麻州波士頓麻州綜合醫院、Fresenius Medical Care North America的Kevin Chan醫師寫道,發現[末期腎病患者]的心臟停止預測標記可以改變腎臟科實務,因為透析患者每年的心臟停止風險達到5%。
  
  他們發現,沒有住在一起的遺傳相關家庭成員,有接受透析者的心臟停止風險,比表型匹配但無親屬關係、同樣接受透析的對照組高88% (勝算比[OR],1.88;95%信賴區間[95% CI],1.25 - 2.84)。
  
  整體而言,研究者發現,這個世代研究中,親屬組死於心臟停止者為4.3%,對照組為2.6%,他們計算發現,住在一起的遺傳相關家屬,心臟停止風險比沒親屬關係的透析患者高66%(OR,1.66;95% CI,1.20 - 2.28)。
  
  相對的,配偶接受透析,屬於住在相同環境但是遺傳上無關,心臟停止風險沒有增加(OR,0.95;95% CI,0.60 - 1.59)。
  
  Chen醫師等人寫道,整體來看,我們的研究認為,對於透析患者,家族史顯著增加了致命的心臟停止風險達近70%,而同居或分居的家庭成員的風險則沒有大變化。
  
  研究團隊檢視了5,117組病患,與長期透析機構的650,000名末期腎病患者來自相同家庭;其中4,053對是遺傳上相關,後續分成住在一起(n =2449)或沒有住在一起(n = 1604),其餘1,064對則是沒有遺傳關係的配偶。
  
  使用多變項邏輯模式確認遺傳的影響程度以及心臟停止相關的後天因素。
  
  研究顯示,相較於沒有心臟停止家族史者,非配偶的親戚曾死於心臟停止者,則患者死於心臟停止風險增加45%(OR,1.45;95% CI,1.19 - 1.75)。
  
  與心臟停止風險增加有關的其他重要因素,包括年齡、黑人、血清鉀濃度、紅血球生成素劑量、曾發生冠狀動脈疾病;與心臟停止風險較低有關的保護因子,包括較高的白蛋白值以及低鈣透析液浴。
  
  Chan醫師在新聞稿中表示,這些研究結果認為遺傳因素—或DNA序列尚的差異—造成透析患者的猝逝風險較高;未來需要更多有關透析族群的遺傳研究,以釐清可以用來解釋心臟停止高風險的特定基因,並為這些患者找到新療法。
  
  接受透析次數20次以上的病患可能比一般人更容易發生心臟停止。
  
  資料來源: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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