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both in type 1 diabetes mellitus &#40;T1D&#41; as well as in type 2 &#40;T2D&#41;&#46;<span class="elsevierStyleSup">4-7</span></p><p class="elsevierStylePara">The association between the Hp genotype and microvascular complications in diabetes has been less studied&#46; Until now&#44; few studies have focused on the implications of Hp in the risk of diabetic nephropathy &#40;DN&#41;&#44; using heterogeneous populations of patients with T1D&#44; with contradictory results to date&#46;<span class="elsevierStyleSup">8-11</span></p><p class="elsevierStylePara">In light of these findings&#44; the objective of our study is to investigate whether the genotype 2-2 of Hp is associated with an increased risk of DN in a Spanish population with T1D&#46;</p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">MATERIAL AND METHOD</span></p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara">A case-control study was designed for a Spanish population&#46; All the patients were selected from the Biobank database &#40;DNA bank&#41; from the Institut d&#8217;Investigacions Biom&#232;diques August Pi i Sunyer &#40;IDIBAPS&#41; and from the Spanish Biomedical Research Centre in Diabetes and Associated Metabolic Disorders &#40;CIBERDEM&#41;&#44; a technical and scientific infrastructure that coordinates the obtaining&#44; processing&#44; storage and provision of biological samples &#40;http&#58;&#47;&#47;www&#46;clinicbiobanc&#46;org&#47;en&#95;index&#46;html&#41;&#46; The cases were defined as all the patients registered in the Biobank with T1D and stage&#160;5 chronic renal failure of the National Kidney Foundation Kidney Disease Outcomes Quality Initiative&#44; awaiting reno-pancreatic transplantation or having already been transplanted &#40;reno-pancreatic or renal alone&#41;&#46;</p><p class="elsevierStylePara">The controls were defined as patients with T1D and preserved renal function &#40;estimated glomerular filtration &#91;eGFR&#93; &#62;&#160;90ml&#47;min&#47;1&#46;73m<span class="elsevierStyleSup">2</span>&#41; and normal urinary excretion of albumin&#44; paired with the cases by sex and time of diabetes evolution &#40;matching by frequency&#41;&#46; T1D evolution time was defined as the years between the diagnosis of diabetes and the date on reaching an eGFR &#60;&#160;15ml&#47;min&#47;1&#46;73m<span class="elsevierStyleSup">2</span> &#40;for the cases&#41; and between the diagnosis of the illness and the entry date into the database of Biobank &#40;for the controls&#41;&#46;</p><p class="elsevierStylePara">The clinical data collected were&#58; sex&#44; age&#44; age at diagnosis of T1D and duration of T1D until entry into the Biobank database &#40;controls&#41; or until the transplant or renal replacement therapy &#40;cases&#41;&#46; Hp genotyping was carried out using samples of DNA supplied by Biobank via polymerase chain reaction following the protocol of Koch et al&#46;<span class="elsevierStyleSup">12</span>&#46;</p><p class="elsevierStylePara">The study protocol was performed in agreement with the Declaration of Helsinki and was approved by the Ethics Committee of both Hospital Cl&#237;nic i Universitari de Barcelona and Biobank&#46; Informed consent of the subjects of the study was obtained&#46;</p><p class="elsevierStylePara">Statistical analysis was carried out using the STATA&#46;11 statistical package&#46; Numerical variables are shown as means and standard deviations for the continuous variables&#44; and as a number and percentage for categorical variables&#46; The Student&#8217;s t-test was used for the comparison of continuous variables and the chi-squared<span class="elsevierStyleSup"> </span>test for categorical variables&#46; Logistic regression models were constructed in order to study the association between the genotype 2-2 of Hp and DN&#46; The Hardy-Weinberg equilibrium study for the genotype of Hp was analysed with 1&#160;degree of freedom&#46; Statistical significance was established at <span class="elsevierStyleItalic">P</span> values&#160;&#60;&#46;05&#46;</p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">RESULTS</span></p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara">114&#160;patients were included in the study&#44; 57&#160;cases and 57&#160;controls&#46; There were no statistically significant differences in sex &#40;70&#160;&#37; vs&#46; 61&#160;&#37; males&#44; <span class="elsevierStyleItalic">P</span>&#61;1&#46;0&#41; or the duration of diabetes &#40;23&#46;0&#160;&#177;&#160;6&#46;7 vs&#46; 20&#46;8&#160;&#177;&#160;9&#46;3&#160;years&#44; <span class="elsevierStyleItalic">P</span>&#61;&#46;1&#41;&#46; However&#44; the cases were older &#40;44&#46;9&#160;&#177;&#160;8&#46;6 vs&#46; 40&#46;9&#160;&#177;&#160;9&#46;5&#160;years&#44; <span class="elsevierStyleItalic">P</span>&#61;&#46;02&#41; and the age at onset of diabetes was lower &#40;14&#46;1&#160;&#177;&#160;6&#46;8 vs&#46; 17&#46;7&#160;&#177;&#160;10&#46;1&#160;years&#44; <span class="elsevierStyleItalic">P</span>&#61;&#46;03&#41;&#46;</p><p class="elsevierStylePara">The distribution of genotypes in our sample was in Hardy-Weinberg equilibrium&#46; The prevalence of the genotype 1-1&#44; 2-1 and 2-2 of Hp was 19&#46;3&#160;&#37;&#44; 42&#46;1&#160;&#37; and 38&#46;6&#160;&#37; in cases&#44; and 17&#46;5&#160;&#37;&#44; 49&#46;1&#160;&#37; and 33&#46;4&#160;&#37; in controls&#44; respectively&#46; There were no differences in the frequency of the different genotypes or in the frequency of the different alleles between cases and controls &#40;Table&#160;1&#41;&#46; The logistic regression study&#44; including sex and the time of T1D evolution as covariables in the model&#44; did not show a statistically significant association between the genotype 2-2 of Hp and the development of DN &#40;odds ratio 1&#46;14&#44; confidence of interval 0&#46;52-2&#46;52&#41;&#46;</p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">DISCUSSION</span></p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara">In this case-control study in a Spanish population&#44; we did not find a association between the Hp genotype and the presence of DN in patients with T1D&#44; despite careful patient selection&#44; representing the extremes of the DN spectrum with the same time of diabetes evolution&#46;</p><p class="elsevierStylePara">The contribution of the genotype of Hp to the risk of CVD has been analysed in various longitudinal studies&#44; relating the genotype 2-2 with an increased risk of CVD in patients with T1D and T2D&#46;<span class="elsevierStyleSup">4-7</span> This association could have some implications in the treatment of patients with diabetes&#44; given that vitamin&#160;E supplement has shown to reduce cardiovascular events&#44;<span class="elsevierStyleSup">13&#44;14</span> mostly in those patients with T2D&#46;</p><p class="elsevierStylePara">With respect to microvascular complications of diabetes&#44; this association is less consistent&#46; In fact&#44; there have been few studies on the relation between the genotype of Hp and the risk of diabetic retinopathy&#44; with contradictory results to date<span class="elsevierStyleSup">15&#44;16</span>&#46;</p><p class="elsevierStylePara">Some studies have studied the association between the Hp genotype and the risk of DN&#44; but only four included patients with T1D&#46;<span class="elsevierStyleSup">8-11</span> The first study&#44;<span class="elsevierStyleSup">8</span> which included patients both with T1D and T2D&#44; showed a significant increase of the genotype 2-2 in patients with micro- and macroalbuminuria versus the other genotypes&#46; The second study &#40;case-control&#41;<span class="elsevierStyleSup">9</span> included 509&#160;Irish patients with T1D&#44; defining DN as the presence of proteinuria above 0&#46;5g&#47;24h&#46; This study did not show statistically significant differences between the three genotypes&#44; although a higher frequency of allele&#160;2 of Hp was discovered in the cases&#46; The third study<span class="elsevierStyleSup">10</span> included 95&#160;patients with T1D and 170 with T2D&#44; without finding an association between the genotype of Hp and the presence of DN &#40;defined as the presence of micro- or macroalbuminuria&#41;&#46; The last&#44;<span class="elsevierStyleSup">11</span> and the only prospective study&#44; included 486&#160;patients with T1D&#44; with a mean follow-up of 18&#160;years&#46; No relation was found between the genotype of Hp and the risk of DN in univariate models&#44; although in multivariate models a risk nearly two times greater of a decrease in eGFR and of chronic kidney disease with the genotype 2-2 of Hp was discovered&#46;</p><p class="elsevierStylePara">In light of the different definitions used for DN in different studies&#44; we decided to carry out a genetic study in patients with no indication of DN &#40;controls&#41; and to compare them with those with a more serious form of DN &#40;cases&#41;&#44; with the same duration of T1D&#46; The frequency of the different genotypes of Hp was very similar to that of previous studies which have analysed the frequency of genotypes of Hp in a Spanish population<span class="elsevierStyleSup">17</span>&#46; However&#44; we have not found a link between the genotype 2-2 and a higher frequency of DN &#40;38&#46;6&#160;&#37; in cases and 33&#46;4&#160;&#37; in controls&#59; <span class="elsevierStyleItalic">P</span>&#61;&#46;8&#41; or a protective effect of the genotype 1-1 &#40;19&#46;3&#160;&#37; in cases and 17&#46;5&#160;&#37; in controls&#59; <span class="elsevierStyleItalic">P</span>&#61;&#46;8&#41;&#46;</p><p class="elsevierStylePara">Our study is not without its limitations&#46; Given that our cases had very restricted selection criteria&#44; our sample of patients with T1D is limited&#46; In addition&#44; we do not know the longitudinal information about the metabolic control or other confounding factors that could influence the evolution of DN&#44; such as smoking or hypertension&#46;</p><p class="elsevierStylePara">In conclusion&#44; in our sample of Spanish patients with T1D&#44; the genotype of Hp did not appear to have an implication for the risk of DN&#46; In light of our results and the contradictory results from other studies&#44; more studies are needed&#44; with a wider sample group and of prospective nature&#44; in order to clarify the role of Hp in the risk of microvascular complications in T1D&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">&#160;</span></p><p class="elsevierStylePara"><span class="elsevierStyleBold">ACKNOWLEDGEMENTS</span></p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara">We would like to thank Biobank of IDIBAPS and CIBERDEM for the samples and for the technical assistance provided&#46;</p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Conflicts of interest</span>&#160;&#160;&#160;&#160;&#160;&#160;&#160;&#160;&#160;&#160;&#160;&#160;&#160;&#160;&#160;&#160;&#160;&#160;&#160;&#160;&#160;&#160;&#160;&#160;&#160;&#160;&#160;&#160;&#160;&#160;&#160;&#160;&#160;&#160;</p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara">The authors declare that they have no conflicts of interest related to the contents of this article&#46;</p><p class="elsevierStylePara"><a href="grande&#47;12034&#95;16025&#95;56443&#95;en&#95;t1&#95;9&#46;12034&#95;02&#46;jpg" class="elsevierStyleCrossRefs"><img src="12034_16025_56443_en_t1_9.12034_02.jpg" alt="Haptoglobin genotype and frequencies of the alleles in the population of the study"></img></a></p><p class="elsevierStylePara">Table 1&#46; Haptoglobin genotype and frequencies of the alleles in the population of the study</p>"
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        "resumen" => "<p class="elsevierStylePara"><span class="elsevierStyleBold">Antecedentes&#58; </span>Pocos trabajos han estudiado la asociaci&#243;n entre el genotipo de la haptoglobina &#40;Hp&#41; y el riesgo de nefropat&#237;a diab&#233;tica &#40;ND&#41; en pacientes con diabetes tipo 1 &#40;DM1&#41;&#44; con resultados contradictorios hasta ahora&#46; <span class="elsevierStyleBold">Objetivos&#58; </span>Estudiar si el genotipo 2-2 de Hp se asocia a un incremento del riesgo de ND en poblaci&#243;n espa&#241;ola con DM1&#46; <span class="elsevierStyleBold">M&#233;todos&#58; </span>Se dise&#241;&#243; un estudio de casos y controles&#46; CASOS&#58; pacientes con DM1 y enfermedad renal cr&#243;nica estadio 5 de la NKF-KDOQI&#44; en espera de trasplante reno-pancre&#225;tico o que han sido trasplantados &#40;reno-pancre&#225;tico o renal aislado&#41;&#46; CONTROLES&#58; pacientes con DM1&#44; apareados por sexo y tiempo de evoluci&#243;n de la diabetes&#44; con funci&#243;n renal y excreci&#243;n urinaria de alb&#250;mina normales&#46; El genotipo de Hp se realiz&#243; mediante reacci&#243;n en cadena de la polimerasa y electroforesis&#46; <span class="elsevierStyleBold">Resultados&#58; </span>Incluimos 57 casos y 57 controles&#44; sin diferencias estad&#237;sticamente significativas en el sexo &#40;70&#160;&#37; frente a 61&#160;&#37; varones&#44; p&#160;&#61;&#160;1&#44;0&#41; o duraci&#243;n de la diabetes &#40;23&#44;0&#160;&#177;&#160;6&#44;7 frente a 20&#44;8&#160;&#177;&#160;9&#44;3 a&#241;os&#59; p&#160;&#61;&#160;0&#44;1&#41;&#44; aunque la edad de inicio de la diabetes fue menor en los casos &#40;14&#44;1&#160;&#177;&#160;6&#44;8 frente a 17&#44;7&#160;&#177;&#160;10&#44;1 a&#241;os&#44; p&#160;&#61;&#160;0&#44;03&#41;&#46; La frecuencia de genotipos 1-1&#44; 1-2 y 2-2 fue de 19&#44;3&#160;&#37;&#44; 42&#44;1&#160;&#37; y 38&#44;6&#160;&#37; en los casos y de 17&#44;5&#160;&#37;&#44; 49&#44;1&#160;&#37; y 33&#44;4&#160;&#37; en los controles&#44; respectivamente&#44; sin diferencias significativas &#40;p&#160;&#61;&#160;0&#44;8&#41;&#46; El an&#225;lisis de regresi&#243;n log&#237;stica condicional no mostr&#243; asociaci&#243;n entre el genotipo 2-2 de Hp y el desarrollo de ND &#40;OR 1&#44;14&#44; IC 0&#44;52-2&#44;52&#41;&#46; <span class="elsevierStyleBold">Conclusiones&#58; </span>En nuestra muestra de poblaci&#243;n espa&#241;ola con DM1&#44; no se ha hallado asociaci&#243;n entre el genotipo de Hp y el riesgo de ND&#46;</p>"
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        "resumen" => "<p class="elsevierStylePara"><span class="elsevierStyleBold">Background&#58;</span><span class="elsevierStyleBold"> </span>Few reports have studied the possible association between the haptoglobin &#40;Hp&#41; genotype and the risk of diabetic nephropathy &#40;DN&#41; in type 1 diabetes &#40;T1D&#41;&#44; with conflicting results to date&#46; <span class="elsevierStyleBold">Aims&#58;</span> To study whether the 2-2 Hp genotype is associated with an increased risk of overt DN in a Spanish population with T1D&#46; <span class="elsevierStyleBold">Methods&#58;</span> We performed a case-control study in a Spanish population&#46; CASES&#58; T1D patients with end-stage renal disease &#40;stage 5 of NKF-KDOQI&#41;&#44; awaiting reno-pancreatic transplantation or having already been transplanted &#40;reno-pancreatic or renal alone&#41;&#46; CONTROLS&#58; T1D patients&#44; matched for sex and time of diabetes evolution&#44; with preserved renal function and normal urinary albumin excretion&#46; Hp genotyping was done using polymerase chain reaction and electrophoresis&#46; <span class="elsevierStyleBold">Results&#58;</span> We included 57 cases and 57 controls in the study&#46; There were no statistically significant differences in gender &#40;70&#37; vs&#46; 61&#37; males&#44; p&#61;1&#46;0&#41; or the duration of diabetes &#40;23&#46;0&#177;6&#46;7 vs&#46; 20&#46;8&#177;9&#46;3 years&#59; p&#61;0&#46;1&#41;&#44; although the age of onset of diabetes was lower in the cases &#40;14&#46;1&#177;6&#46;8 vs&#46; 17&#46;7&#177;10&#46;1 years&#44; p&#61;0&#46;03&#41;&#46; The frequency of genotypes 1-1&#44; 1-2 and 2-2 was 19&#46;3&#37;&#44; 42&#46;1&#37; and 38&#46;6&#37; in cases and 17&#46;5&#37;&#44; 49&#46;1&#37; and 33&#46;4&#37; in controls&#44; respectively&#44; with no statistically significant differences between groups &#40;p&#61;0&#46;8&#41;&#46; Conditional logistic regression analysis showed no significant association between genotype 2-2 of Hp and the development of DN &#40;OR 1&#46;14&#44; CI 0&#46;52-2&#46;52&#41;&#46; <span class="elsevierStyleBold">Conclusions&#58;</span><span class="elsevierStyleBold"> </span>In our sample of a Spanish population with T1D&#44; no association was found between the Hp genotype and risk of overt DN&#46;</p>"
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Haptoglobin genotype and risk of diabetic nephropathy in patients with type 1 diabetes mellitus: a study on a Spanish population
Genotipo de la haptoglobina y riesgo de nefropatía diabética en pacientes con diabetes mellitus tipo 1: estudio en población española
Antonio J. Amora, Silvia Canivellb, Josep Oriolac, Maria J. Ricartd, Ana M. de Hollandaa, Anna Bosch-Comase, Enric Esmatjesa
a Unidad de Diabetes. Servicio de Endocrinología y Nutrición. Institut d¿Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM). Hospital Clínic i Universitari de Barcelona,
b Diabetes and Obesity Laboratory. Endocrinology and Nutrition Unit. IDIBAPS/CIBERDEM, Hospital Clínic i Universitari de Barcelona,
c Servicio de Bioquímica y Genética Molecular, Hospital Clínic i Universitari de Barcelona,
d Unidad de Trasplante Renal, Hospital Clínic i Universitari de Barcelona,
e Biobank, Institut d¿Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona,
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        "titulo" => "Genotipo de la haptoglobina y riesgo de nefropat&#237;a diab&#233;tica en pacientes con diabetes mellitus tipo 1&#58; estudio en poblaci&#243;n espa&#241;ola"
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    "textoCompleto" => "<p class="elsevierStylePara"><span class="elsevierStyleBold">INTRODUCTION</span></p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara">Haptoglobin &#40;Hp&#41; is a protein that acts as an antioxidant due to its ability to combine with haemoglobin and prevent tissue damage caused by free haemoglobin&#46; The Hp gene is polymorphic&#44; with two types of alleles&#44; named 1 and 2&#44; resulting in three potential genotypes of Hp&#58; Hp 1-1&#44; Hp 2-1 and Hp 2-2&#46;<span class="elsevierStyleSup">1</span> The protein derived from allele 2 of Hp provides less antioxidant activity than the protein of allele 1&#46;<span class="elsevierStyleSup">1&#44;2</span></p><p class="elsevierStylePara">There is increasing evidence in medical literature of the association between the genotype of Hp and cardiovascular disease &#40;CVD&#41;&#46;<span class="elsevierStyleSup">3</span> In this respect&#44; various longitudinal epidemiological studies have found a risk of CVD 2 to 8 times greater in patients with diabetes mellitus with the Hp genotype 2-2&#44; both in type 1 diabetes mellitus &#40;T1D&#41; as well as in type 2 &#40;T2D&#41;&#46;<span class="elsevierStyleSup">4-7</span></p><p class="elsevierStylePara">The association between the Hp genotype and microvascular complications in diabetes has been less studied&#46; Until now&#44; few studies have focused on the implications of Hp in the risk of diabetic nephropathy &#40;DN&#41;&#44; using heterogeneous populations of patients with T1D&#44; with contradictory results to date&#46;<span class="elsevierStyleSup">8-11</span></p><p class="elsevierStylePara">In light of these findings&#44; the objective of our study is to investigate whether the genotype 2-2 of Hp is associated with an increased risk of DN in a Spanish population with T1D&#46;</p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">MATERIAL AND METHOD</span></p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara">A case-control study was designed for a Spanish population&#46; All the patients were selected from the Biobank database &#40;DNA bank&#41; from the Institut d&#8217;Investigacions Biom&#232;diques August Pi i Sunyer &#40;IDIBAPS&#41; and from the Spanish Biomedical Research Centre in Diabetes and Associated Metabolic Disorders &#40;CIBERDEM&#41;&#44; a technical and scientific infrastructure that coordinates the obtaining&#44; processing&#44; storage and provision of biological samples &#40;http&#58;&#47;&#47;www&#46;clinicbiobanc&#46;org&#47;en&#95;index&#46;html&#41;&#46; The cases were defined as all the patients registered in the Biobank with T1D and stage&#160;5 chronic renal failure of the National Kidney Foundation Kidney Disease Outcomes Quality Initiative&#44; awaiting reno-pancreatic transplantation or having already been transplanted &#40;reno-pancreatic or renal alone&#41;&#46;</p><p class="elsevierStylePara">The controls were defined as patients with T1D and preserved renal function &#40;estimated glomerular filtration &#91;eGFR&#93; &#62;&#160;90ml&#47;min&#47;1&#46;73m<span class="elsevierStyleSup">2</span>&#41; and normal urinary excretion of albumin&#44; paired with the cases by sex and time of diabetes evolution &#40;matching by frequency&#41;&#46; T1D evolution time was defined as the years between the diagnosis of diabetes and the date on reaching an eGFR &#60;&#160;15ml&#47;min&#47;1&#46;73m<span class="elsevierStyleSup">2</span> &#40;for the cases&#41; and between the diagnosis of the illness and the entry date into the database of Biobank &#40;for the controls&#41;&#46;</p><p class="elsevierStylePara">The clinical data collected were&#58; sex&#44; age&#44; age at diagnosis of T1D and duration of T1D until entry into the Biobank database &#40;controls&#41; or until the transplant or renal replacement therapy &#40;cases&#41;&#46; Hp genotyping was carried out using samples of DNA supplied by Biobank via polymerase chain reaction following the protocol of Koch et al&#46;<span class="elsevierStyleSup">12</span>&#46;</p><p class="elsevierStylePara">The study protocol was performed in agreement with the Declaration of Helsinki and was approved by the Ethics Committee of both Hospital Cl&#237;nic i Universitari de Barcelona and Biobank&#46; Informed consent of the subjects of the study was obtained&#46;</p><p class="elsevierStylePara">Statistical analysis was carried out using the STATA&#46;11 statistical package&#46; Numerical variables are shown as means and standard deviations for the continuous variables&#44; and as a number and percentage for categorical variables&#46; The Student&#8217;s t-test was used for the comparison of continuous variables and the chi-squared<span class="elsevierStyleSup"> </span>test for categorical variables&#46; Logistic regression models were constructed in order to study the association between the genotype 2-2 of Hp and DN&#46; The Hardy-Weinberg equilibrium study for the genotype of Hp was analysed with 1&#160;degree of freedom&#46; Statistical significance was established at <span class="elsevierStyleItalic">P</span> values&#160;&#60;&#46;05&#46;</p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">RESULTS</span></p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara">114&#160;patients were included in the study&#44; 57&#160;cases and 57&#160;controls&#46; There were no statistically significant differences in sex &#40;70&#160;&#37; vs&#46; 61&#160;&#37; males&#44; <span class="elsevierStyleItalic">P</span>&#61;1&#46;0&#41; or the duration of diabetes &#40;23&#46;0&#160;&#177;&#160;6&#46;7 vs&#46; 20&#46;8&#160;&#177;&#160;9&#46;3&#160;years&#44; <span class="elsevierStyleItalic">P</span>&#61;&#46;1&#41;&#46; However&#44; the cases were older &#40;44&#46;9&#160;&#177;&#160;8&#46;6 vs&#46; 40&#46;9&#160;&#177;&#160;9&#46;5&#160;years&#44; <span class="elsevierStyleItalic">P</span>&#61;&#46;02&#41; and the age at onset of diabetes was lower &#40;14&#46;1&#160;&#177;&#160;6&#46;8 vs&#46; 17&#46;7&#160;&#177;&#160;10&#46;1&#160;years&#44; <span class="elsevierStyleItalic">P</span>&#61;&#46;03&#41;&#46;</p><p class="elsevierStylePara">The distribution of genotypes in our sample was in Hardy-Weinberg equilibrium&#46; The prevalence of the genotype 1-1&#44; 2-1 and 2-2 of Hp was 19&#46;3&#160;&#37;&#44; 42&#46;1&#160;&#37; and 38&#46;6&#160;&#37; in cases&#44; and 17&#46;5&#160;&#37;&#44; 49&#46;1&#160;&#37; and 33&#46;4&#160;&#37; in controls&#44; respectively&#46; There were no differences in the frequency of the different genotypes or in the frequency of the different alleles between cases and controls &#40;Table&#160;1&#41;&#46; The logistic regression study&#44; including sex and the time of T1D evolution as covariables in the model&#44; did not show a statistically significant association between the genotype 2-2 of Hp and the development of DN &#40;odds ratio 1&#46;14&#44; confidence of interval 0&#46;52-2&#46;52&#41;&#46;</p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">DISCUSSION</span></p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara">In this case-control study in a Spanish population&#44; we did not find a association between the Hp genotype and the presence of DN in patients with T1D&#44; despite careful patient selection&#44; representing the extremes of the DN spectrum with the same time of diabetes evolution&#46;</p><p class="elsevierStylePara">The contribution of the genotype of Hp to the risk of CVD has been analysed in various longitudinal studies&#44; relating the genotype 2-2 with an increased risk of CVD in patients with T1D and T2D&#46;<span class="elsevierStyleSup">4-7</span> This association could have some implications in the treatment of patients with diabetes&#44; given that vitamin&#160;E supplement has shown to reduce cardiovascular events&#44;<span class="elsevierStyleSup">13&#44;14</span> mostly in those patients with T2D&#46;</p><p class="elsevierStylePara">With respect to microvascular complications of diabetes&#44; this association is less consistent&#46; In fact&#44; there have been few studies on the relation between the genotype of Hp and the risk of diabetic retinopathy&#44; with contradictory results to date<span class="elsevierStyleSup">15&#44;16</span>&#46;</p><p class="elsevierStylePara">Some studies have studied the association between the Hp genotype and the risk of DN&#44; but only four included patients with T1D&#46;<span class="elsevierStyleSup">8-11</span> The first study&#44;<span class="elsevierStyleSup">8</span> which included patients both with T1D and T2D&#44; showed a significant increase of the genotype 2-2 in patients with micro- and macroalbuminuria versus the other genotypes&#46; The second study &#40;case-control&#41;<span class="elsevierStyleSup">9</span> included 509&#160;Irish patients with T1D&#44; defining DN as the presence of proteinuria above 0&#46;5g&#47;24h&#46; This study did not show statistically significant differences between the three genotypes&#44; although a higher frequency of allele&#160;2 of Hp was discovered in the cases&#46; The third study<span class="elsevierStyleSup">10</span> included 95&#160;patients with T1D and 170 with T2D&#44; without finding an association between the genotype of Hp and the presence of DN &#40;defined as the presence of micro- or macroalbuminuria&#41;&#46; The last&#44;<span class="elsevierStyleSup">11</span> and the only prospective study&#44; included 486&#160;patients with T1D&#44; with a mean follow-up of 18&#160;years&#46; No relation was found between the genotype of Hp and the risk of DN in univariate models&#44; although in multivariate models a risk nearly two times greater of a decrease in eGFR and of chronic kidney disease with the genotype 2-2 of Hp was discovered&#46;</p><p class="elsevierStylePara">In light of the different definitions used for DN in different studies&#44; we decided to carry out a genetic study in patients with no indication of DN &#40;controls&#41; and to compare them with those with a more serious form of DN &#40;cases&#41;&#44; with the same duration of T1D&#46; The frequency of the different genotypes of Hp was very similar to that of previous studies which have analysed the frequency of genotypes of Hp in a Spanish population<span class="elsevierStyleSup">17</span>&#46; However&#44; we have not found a link between the genotype 2-2 and a higher frequency of DN &#40;38&#46;6&#160;&#37; in cases and 33&#46;4&#160;&#37; in controls&#59; <span class="elsevierStyleItalic">P</span>&#61;&#46;8&#41; or a protective effect of the genotype 1-1 &#40;19&#46;3&#160;&#37; in cases and 17&#46;5&#160;&#37; in controls&#59; <span class="elsevierStyleItalic">P</span>&#61;&#46;8&#41;&#46;</p><p class="elsevierStylePara">Our study is not without its limitations&#46; Given that our cases had very restricted selection criteria&#44; our sample of patients with T1D is limited&#46; In addition&#44; we do not know the longitudinal information about the metabolic control or other confounding factors that could influence the evolution of DN&#44; such as smoking or hypertension&#46;</p><p class="elsevierStylePara">In conclusion&#44; in our sample of Spanish patients with T1D&#44; the genotype of Hp did not appear to have an implication for the risk of DN&#46; In light of our results and the contradictory results from other studies&#44; more studies are needed&#44; with a wider sample group and of prospective nature&#44; in order to clarify the role of Hp in the risk of microvascular complications in T1D&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">&#160;</span></p><p class="elsevierStylePara"><span class="elsevierStyleBold">ACKNOWLEDGEMENTS</span></p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara">We would like to thank Biobank of IDIBAPS and CIBERDEM for the samples and for the technical assistance provided&#46;</p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Conflicts of interest</span>&#160;&#160;&#160;&#160;&#160;&#160;&#160;&#160;&#160;&#160;&#160;&#160;&#160;&#160;&#160;&#160;&#160;&#160;&#160;&#160;&#160;&#160;&#160;&#160;&#160;&#160;&#160;&#160;&#160;&#160;&#160;&#160;&#160;&#160;</p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara">The authors declare that they have no conflicts of interest related to the contents of this article&#46;</p><p class="elsevierStylePara"><a href="grande&#47;12034&#95;16025&#95;56443&#95;en&#95;t1&#95;9&#46;12034&#95;02&#46;jpg" class="elsevierStyleCrossRefs"><img src="12034_16025_56443_en_t1_9.12034_02.jpg" alt="Haptoglobin genotype and frequencies of the alleles in the population of the study"></img></a></p><p class="elsevierStylePara">Table 1&#46; Haptoglobin genotype and frequencies of the alleles in the population of the study</p>"
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        "resumen" => "<p class="elsevierStylePara"><span class="elsevierStyleBold">Antecedentes&#58; </span>Pocos trabajos han estudiado la asociaci&#243;n entre el genotipo de la haptoglobina &#40;Hp&#41; y el riesgo de nefropat&#237;a diab&#233;tica &#40;ND&#41; en pacientes con diabetes tipo 1 &#40;DM1&#41;&#44; con resultados contradictorios hasta ahora&#46; <span class="elsevierStyleBold">Objetivos&#58; </span>Estudiar si el genotipo 2-2 de Hp se asocia a un incremento del riesgo de ND en poblaci&#243;n espa&#241;ola con DM1&#46; <span class="elsevierStyleBold">M&#233;todos&#58; </span>Se dise&#241;&#243; un estudio de casos y controles&#46; CASOS&#58; pacientes con DM1 y enfermedad renal cr&#243;nica estadio 5 de la NKF-KDOQI&#44; en espera de trasplante reno-pancre&#225;tico o que han sido trasplantados &#40;reno-pancre&#225;tico o renal aislado&#41;&#46; CONTROLES&#58; pacientes con DM1&#44; apareados por sexo y tiempo de evoluci&#243;n de la diabetes&#44; con funci&#243;n renal y excreci&#243;n urinaria de alb&#250;mina normales&#46; El genotipo de Hp se realiz&#243; mediante reacci&#243;n en cadena de la polimerasa y electroforesis&#46; <span class="elsevierStyleBold">Resultados&#58; </span>Incluimos 57 casos y 57 controles&#44; sin diferencias estad&#237;sticamente significativas en el sexo &#40;70&#160;&#37; frente a 61&#160;&#37; varones&#44; p&#160;&#61;&#160;1&#44;0&#41; o duraci&#243;n de la diabetes &#40;23&#44;0&#160;&#177;&#160;6&#44;7 frente a 20&#44;8&#160;&#177;&#160;9&#44;3 a&#241;os&#59; p&#160;&#61;&#160;0&#44;1&#41;&#44; aunque la edad de inicio de la diabetes fue menor en los casos &#40;14&#44;1&#160;&#177;&#160;6&#44;8 frente a 17&#44;7&#160;&#177;&#160;10&#44;1 a&#241;os&#44; p&#160;&#61;&#160;0&#44;03&#41;&#46; La frecuencia de genotipos 1-1&#44; 1-2 y 2-2 fue de 19&#44;3&#160;&#37;&#44; 42&#44;1&#160;&#37; y 38&#44;6&#160;&#37; en los casos y de 17&#44;5&#160;&#37;&#44; 49&#44;1&#160;&#37; y 33&#44;4&#160;&#37; en los controles&#44; respectivamente&#44; sin diferencias significativas &#40;p&#160;&#61;&#160;0&#44;8&#41;&#46; El an&#225;lisis de regresi&#243;n log&#237;stica condicional no mostr&#243; asociaci&#243;n entre el genotipo 2-2 de Hp y el desarrollo de ND &#40;OR 1&#44;14&#44; IC 0&#44;52-2&#44;52&#41;&#46; <span class="elsevierStyleBold">Conclusiones&#58; </span>En nuestra muestra de poblaci&#243;n espa&#241;ola con DM1&#44; no se ha hallado asociaci&#243;n entre el genotipo de Hp y el riesgo de ND&#46;</p>"
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        "resumen" => "<p class="elsevierStylePara"><span class="elsevierStyleBold">Background&#58;</span><span class="elsevierStyleBold"> </span>Few reports have studied the possible association between the haptoglobin &#40;Hp&#41; genotype and the risk of diabetic nephropathy &#40;DN&#41; in type 1 diabetes &#40;T1D&#41;&#44; with conflicting results to date&#46; <span class="elsevierStyleBold">Aims&#58;</span> To study whether the 2-2 Hp genotype is associated with an increased risk of overt DN in a Spanish population with T1D&#46; <span class="elsevierStyleBold">Methods&#58;</span> We performed a case-control study in a Spanish population&#46; CASES&#58; T1D patients with end-stage renal disease &#40;stage 5 of NKF-KDOQI&#41;&#44; awaiting reno-pancreatic transplantation or having already been transplanted &#40;reno-pancreatic or renal alone&#41;&#46; CONTROLS&#58; T1D patients&#44; matched for sex and time of diabetes evolution&#44; with preserved renal function and normal urinary albumin excretion&#46; Hp genotyping was done using polymerase chain reaction and electrophoresis&#46; <span class="elsevierStyleBold">Results&#58;</span> We included 57 cases and 57 controls in the study&#46; There were no statistically significant differences in gender &#40;70&#37; vs&#46; 61&#37; males&#44; p&#61;1&#46;0&#41; or the duration of diabetes &#40;23&#46;0&#177;6&#46;7 vs&#46; 20&#46;8&#177;9&#46;3 years&#59; p&#61;0&#46;1&#41;&#44; although the age of onset of diabetes was lower in the cases &#40;14&#46;1&#177;6&#46;8 vs&#46; 17&#46;7&#177;10&#46;1 years&#44; p&#61;0&#46;03&#41;&#46; The frequency of genotypes 1-1&#44; 1-2 and 2-2 was 19&#46;3&#37;&#44; 42&#46;1&#37; and 38&#46;6&#37; in cases and 17&#46;5&#37;&#44; 49&#46;1&#37; and 33&#46;4&#37; in controls&#44; respectively&#44; with no statistically significant differences between groups &#40;p&#61;0&#46;8&#41;&#46; Conditional logistic regression analysis showed no significant association between genotype 2-2 of Hp and the development of DN &#40;OR 1&#46;14&#44; CI 0&#46;52-2&#46;52&#41;&#46; <span class="elsevierStyleBold">Conclusions&#58;</span><span class="elsevierStyleBold"> </span>In our sample of a Spanish population with T1D&#44; no association was found between the Hp genotype and risk of overt DN&#46;</p>"
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