title: APOL1 renal-risk genotypes associate with longer hemodialysis survival in prevalent nondiabetic African American patients with end-stage renal disease.
abstract: Relative to European Americans, evidence supports that African Americans with end-stage renal disease (ESRD) survive longer on dialysis. Renal-risk variants in the apolipoprotein L1 gene (APOL1), associated with nondiabetic nephropathy and less subclinical atherosclerosis, may contribute to dialysis outcomes. Here, APOL1 renal-risk variants were assessed for association with dialytic survival in 450 diabetic and 275 nondiabetic African American hemodialysis patients from Wake Forest and Emory School of Medicine outpatient facilities. Outcomes were provided by the ESRD Network 6-Southeastern Kidney Council Standardized Information Management System. Dates of death, receipt of a kidney transplant, and loss to follow-up were recorded. Outcomes were censored at the date of transplantation or through 1 July 2015. Multivariable Cox proportional hazards models were computed separately in patients with nondiabetic and diabetic ESRD, adjusting for the covariates age, gender, comorbidities, ancestry, and presence of an arteriovenous fistula or graft at dialysis initiation. In nondiabetic ESRD, patients with 2 (vs. 0/1) APOL1 renal-risk variants had significantly longer dialysis survival (hazard ratio 0.57), a pattern not observed in patients with diabetes-associated ESRD (hazard ratio 1.29). Thus, 2 APOL1 renal-risk variants are associated with longer dialysis survival in African Americans without diabetes, potentially relating to presence of renal-limited disease or less atherosclerosis.
authors.affiliation: Department of Internal Medicine, Section on Nephrology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA; Center for Public Health Genomics, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA.
authors.forename: Lijun
authors.initials: L
authors.lastname: Ma
authors.affiliation: Center for Public Health Genomics, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA; Division of Public Health Sciences, Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA.
authors.forename: Carl D
authors.initials: CD
authors.lastname: Langefeld
authors.affiliation: Center for Public Health Genomics, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA; Division of Public Health Sciences, Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA.
authors.forename: Mary E
authors.initials: ME
authors.lastname: Comeau
authors.affiliation: Department of Biochemistry, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA.
authors.forename: Jason A
authors.initials: JA
authors.lastname: Bonomo
authors.affiliation: Department of Internal Medicine, Section on Nephrology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA.
authors.forename: Michael V
authors.initials: MV
authors.lastname: Rocco
authors.affiliation: Department of Internal Medicine, Section on Nephrology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA.
authors.forename: John M
authors.initials: JM
authors.lastname: Burkart
authors.affiliation: Center for Public Health Genomics, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA; Division of Public Health Sciences, Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA.
authors.forename: Jasmin
authors.initials: J
authors.lastname: Divers
authors.affiliation: Center for Public Health Genomics, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA; Department of Biochemistry, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA; Center for Genomics and Personalized Medicine Research, Center for Diabetes Research, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA.
authors.forename: Nicholette D
authors.initials: ND
authors.lastname: Palmer
authors.affiliation: Department of Biochemistry, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA.
authors.forename: Pamela J
authors.initials: PJ
authors.lastname: Hicks
authors.affiliation: Department of Biochemistry, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA; Center for Genomics and Personalized Medicine Research, Center for Diabetes Research, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA.
authors.forename: Donald W
authors.initials: DW
authors.lastname: Bowden
authors.affiliation: Division of Renal Medicine, Department of Internal Medicine, Emory School of Medicine, Atlanta, Georgia, USA.
authors.forename: Janice P
authors.initials: JP
authors.lastname: Lea
authors.affiliation: Southeastern Kidney Council Inc.-ESRD Network 6, Raleigh, North Carolina, USA.
authors.forename: Jenna O
authors.initials: JO
authors.lastname: Krisher
authors.affiliation: Southeastern Kidney Council Inc.-ESRD Network 6, Raleigh, North Carolina, USA.
authors.forename: Margo J
authors.initials: MJ
authors.lastname: Clay
authors.affiliation: Department of Internal Medicine, Section on Nephrology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA; Center for Public Health Genomics, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA; Center for Genomics and Personalized Medicine Research, Center for Diabetes Research, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA. Electronic address: bfreedma@wakehealth.edu.
authors.forename: Barry I
authors.initials: BI
authors.lastname: Freedman
mesh_terms: D001741:Black or African American / Q000235:genetics*; D000368:Aged; D000075944:Apolipoprotein L1; D001053:Apolipoproteins / Q000235:genetics*; D003928:Diabetic Nephropathies / Q000235:genetics / Q000401:mortality* / Q000628:therapy; D005260:Female; D005838:Genotype; D006801:Humans; D007676:Kidney Failure, Chronic / Q000235:genetics / Q000401:mortality* / Q000628:therapy; D016030:Kidney Transplantation; D008075:Lipoproteins, HDL / Q000235:genetics*; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis; D012307:Risk Factors; D016019:Survival Analysis; D044465:White People / Q000235:genetics
chemical_list: C108666:APOL1 protein, human; D000075944:Apolipoprotein L1; D001053:Apolipoproteins; D008075:Lipoproteins, HDL
keywords: APOL1; African Americans; diabetes mellitus; end-stage kidney disease; hemodialysis; survival