Polymorphism in the promoter region of the klotho gene (G-395A) is associated with early dysfunction in vascular access in hemodialysis patients

BACKGROUND/AIMS: Vascular access dysfunction is an important cause of morbidity and mortality in hemodialysis (HD) patients. Recent studies have shown that a klotho gene mutation is related to endothelial dysfunction, thrombosis, and arteriosclerosis, which are regarded as causes of vascular access dysfunction. We investigated the relationship between the klotho G-395A polymorphism and early dysfunction in vascular access in HD patients. METHODS: Patients who underwent vascular access operations between 1999 and 2002 were enrolled (n=126). Genotyping was performed by allelic discrimination using a 5'-nuclease polymerase chain reaction assay. Clinical data that could be relevant to access dysfunction were obtained from medical records. Early dysfunction of vascular access was defined as the need for any angioplastic or surgical intervention to correct or replace a poorly or nonfunctioning vascular access within 1 year and at least 8 weeks after initial access placement. RESULTS: Of the 126 patients, the genotype frequency of G-395A was 72.2% for GG (n=91), 24.6% for GA (n=31), and 3.2% for AA (n=4), and the frequency of minor allele was 0.155. Clinical data were similar between the two groups, divided according to the status of the A allele. Early dysfunction occurred in 34 (27.0%) of patients, but it occurred at a significantly higher rate in A allele carriers (45.7%, 16/35) than in noncarriers (19.8%, 18/91; p=0.003). CONCLUSIONS: Our results suggest that the klotho G-395A polymorphism could be a risk factor for early dysfunction of vascular access in HD patients.

A Case of Therapeutic Embolization of Hemarthrosis due to Pseudoaneurysm / 대한류마티스학회지

Hemarthrosis can occur in patients with a predisposition to hemorrhage such as hemophilia or anticoagulant therapy. A 72-year-old man presented with an acute painful swelling in the right knee. He was on anticoagulant therapy after a mechanical aortic valve replacement due to aortic valve insufficiency. There was no history of trauma and international normalized ratio (INR) was maintained at 3.76. On arthrocentesis of the knee, bloody synovial fluid was obtained. With the diagnosis of hemarthrosis, INR was maintained at 2. With immobilization, the knee pain gradually improved. Three weeks after discharge, right knee painful swelling was exacerbated, and arthrocentesis again revealed bloody synovial fluid. After magnetic resonance imaging (MRI) was performed, pseudoaneurysm of the right lateral superior genicular artery was diagnosed. The angiographic embolization was performed after which, he showed marked improvement. Knee MRI should be considered in hemarthrosis with atypical clinical progress, because it can detect lesions amenable to therapeutic intervention as in this case.