title: Race, APOL1 Risk, and eGFR Decline in the General Population.
abstract: The APOL1 high-risk genotype, present in approximately 13% of blacks in the United States, is a risk factor for kidney function decline in populations with CKD. It is unknown whether genetic screening is indicated in the general population. We evaluated the prognosis of APOL1 high-risk status in participants in the population-based Atherosclerosis Risk in Communities (ARIC) study, including associations with eGFR decline, variability in eGFR decline, and related adverse health events (AKI, ESRD, hypertension, diabetes, cardiovascular disease, pre-ESRD and total hospitalization rate, and mortality). Among 15,140 ARIC participants followed from 1987-1989 (baseline) to 2011-2013, 75.3% were white, 21.5% were black/APOL1 low-risk, and 3.2% were black/APOL1 high-risk. In a demographic-adjusted analysis, blacks had a higher risk for all assessed adverse health events; however, in analyses adjusted for comorbid conditions and socioeconomic status, blacks had a higher risk for hypertension, diabetes, and ESRD only. Among blacks, the APOL1 high-risk genotype associated only with higher risk of ESRD in a fully adjusted analysis. Black race and APOL1 high-risk status were associated with faster eGFR decline (P<0.001 for each). However, we detected substantial overlap among the groups: median (10th-90th percentile) unadjusted eGFR decline was 1.5 (1.0-2.2) ml/min per 1.73 m(2) per year for whites, 2.1 (1.4-3.1) ml/min per 1.73 m(2) per year for blacks with APOL1 low-risk status, and 2.3 (1.5-3.5) ml/min per 1.73 m(2) per year for blacks with APOL1 high-risk status. The high variability in eGFR decline among blacks with and without the APOL1 high-risk genotype suggests that population-based screening is not yet justified.
authors.affiliation: Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland; and Department of Epidemiology and mgrams2@jhmi.edu.
authors.forename: Morgan E
authors.initials: ME
authors.lastname: Grams
authors.affiliation: Department of Epidemiology and.
authors.forename: Casey M
authors.initials: CM
authors.lastname: Rebholz
authors.affiliation: Department of Epidemiology and.
authors.forename: Yuan
authors.initials: Y
authors.lastname: Chen
authors.affiliation: Department of Epidemiology and.
authors.forename: Andreea M
authors.initials: AM
authors.lastname: Rawlings
authors.affiliation: Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland; and.
authors.forename: Michelle M
authors.initials: MM
authors.lastname: Estrella
authors.affiliation: Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland; and Department of Epidemiology and.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Selvin
authors.affiliation: Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland; and Department of Epidemiology and.
authors.forename: Lawrence J
authors.initials: LJ
authors.lastname: Appel
authors.affiliation: Department of Epidemiology and.
authors.forename: Adrienne
authors.initials: A
authors.lastname: Tin
authors.affiliation: Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland; and Department of Epidemiology and Department of Biostatistics, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland.
authors.forename: Josef
authors.initials: J
authors.lastname: Coresh
mesh_terms: D001741:Black or African American; D000075944:Apolipoprotein L1; D001053:Apolipoproteins / Q000235:genetics*; D005260:Female; D005838:Genotype; D005919:Glomerular Filtration Rate; D006801:Humans; D008075:Lipoproteins, HDL / Q000235:genetics*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D051436:Renal Insufficiency, Chronic / Q000453:epidemiology / Q000235:genetics* / Q000503:physiopathology*; D014481:United States / Q000453:epidemiology; D044465:White People
chemical_list: C108666:APOL1 protein, human; D000075944:Apolipoprotein L1; D001053:Apolipoproteins; D008075:Lipoproteins, HDL
keywords: end-stage renal disease; ethnicity; glomerular filtration rate