Association of genetic polymorphisms with acute kidney injury after cardiac surgery in a Southeast Asian population

• Published in: PloS one Vol. 14; no. 4; p. e0213997
• Main Authors: Saw, Kah Ming Eddy, Ng, Rui Ge Roderica, Chan, Siew Pang, Ang, Yi Hui, Ti, Lian Kah, Chew, Tsong Huey Sophia
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 11.04.2019; Public Library of Science (PLoS)
• Subjects: Acute kidney failure; Acute Kidney Injury - epidemiology; Acute Kidney Injury - genetics; Aged; Alleles; Anemia; Anesthesia; Anesthesiology; Angiotensin; Angiotensins; Aorta; Apolipoprotein E; Apolipoproteins; Apolipoproteins E - genetics; Aprotinin; Asian Continental Ancestry Group - genetics; Balloon treatment; Biology and Life Sciences; Cardiac Surgical Procedures - adverse effects; Cardiovascular disease; Care and treatment; Complications and side effects; Coronary artery bypass; Coronary vessels; Cytokines; Demographics; Deoxyribonucleic acid; Diagnosis; DNA; Enzymes; Female; Genes; Genetic factors; Genetic polymorphisms; Heart; Heart surgery; Hospitals; Humans; Hypertension; Interleukin 6; Interleukin-6 - genetics; Interleukins; Kidneys; Male; Medicine and Health Sciences; Middle Aged; Necrosis; Patients; Peptidyl-dipeptidase A; Peptidyl-Dipeptidase A - genetics; Polymorphism; Polymorphism, Genetic; Population; Population genetics; Postoperative Complications - epidemiology; Postoperative Complications - genetics; Prediction models; Renal function; Research and Analysis Methods; Retrospective Studies; Risk analysis; Risk Assessment - methods; Risk Factors; Singapore - epidemiology; Surgery; TNF inhibitors; Tumor necrosis factor; Tumor Necrosis Factor-alpha - genetics; Tumor necrosis factor-TNF; Tumor necrosis factor-α; Tumors; Singapore
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0213997

Genetic polymorphisms are important in explaining the wide interpatient variability that exists in the development of acute kidney injury (AKI) post cardiac surgery. We hypothesised that polymorphisms in 4 candidate genes, namely angiotensin-converting enzyme (ACE), apolipoprotein-E (ApoE), interleukin-6 (IL-6), and tumour necrosis factor-alpha (TNF-α) are associated with AKI. 870 patients who underwent cardiac surgery in Singapore were analysed. All patients who fulfilled stage 1 KDIGO criteria and above were considered to have AKI. This was investigated against various demographic, clinical and genetic factors. Increased age, history of hypertension, anaemia and renal impairment remained important preoperative risk factors for AKI. Intraoperatively, longer cardiopulmonary bypass (CPB) time and the use of intra-aortic balloon pump (IABP) were shown to be associated with AKI. Among the genetic factors, ACE-D allele was associated with an increased risk of AKI while IL6-572C allele was associated with a decreased risk of AKI. ACE-D allele was associated with the development of AKI similar to other studies. On the other hand, IL6-572C was shown to have a protective role against the development of AKI, contradictory to studies done in the Caucasian population. This contradictory effect of IL6-572C is a result of a complex interplay between the gene and population specific modulating factors. Our findings further underscored the necessity of taking into account population specific differences when developing prediction models for AKI.