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Clinical Epidemiology
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Race, APOL1 Risk, and eGFR Decline in the General Population

Morgan E. Grams, Casey M. Rebholz, Yuan Chen, Andreea M. Rawlings, Michelle M. Estrella, Elizabeth Selvin, Lawrence J. Appel, Adrienne Tin and Josef Coresh
JASN September 2016, 27 (9) 2842-2850; DOI: https://doi.org/10.1681/ASN.2015070763
Morgan E. Grams
*Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland; and
Department of †Epidemiology and
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Casey M. Rebholz
Department of †Epidemiology and
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Yuan Chen
Department of †Epidemiology and
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Andreea M. Rawlings
Department of †Epidemiology and
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Michelle M. Estrella
*Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland; and
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Elizabeth Selvin
*Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland; and
Department of †Epidemiology and
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Lawrence J. Appel
*Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland; and
Department of †Epidemiology and
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Adrienne Tin
Department of †Epidemiology and
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Josef Coresh
*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
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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 m2 per year for whites, 2.1 (1.4–3.1) ml/min per 1.73 m2 per year for blacks with APOL1 low-risk status, and 2.3 (1.5–3.5) ml/min per 1.73 m2 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.

  • end-stage renal disease
  • glomerular filtration rate
  • ethnicity
  • Copyright © 2016 by the American Society of Nephrology
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Journal of the American Society of Nephrology: 27 (9)
Journal of the American Society of Nephrology
Vol. 27, Issue 9
September 2016
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Race, APOL1 Risk, and eGFR Decline in the General Population
Morgan E. Grams, Casey M. Rebholz, Yuan Chen, Andreea M. Rawlings, Michelle M. Estrella, Elizabeth Selvin, Lawrence J. Appel, Adrienne Tin, Josef Coresh
JASN Sep 2016, 27 (9) 2842-2850; DOI: 10.1681/ASN.2015070763

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Race, APOL1 Risk, and eGFR Decline in the General Population
Morgan E. Grams, Casey M. Rebholz, Yuan Chen, Andreea M. Rawlings, Michelle M. Estrella, Elizabeth Selvin, Lawrence J. Appel, Adrienne Tin, Josef Coresh
JASN Sep 2016, 27 (9) 2842-2850; DOI: 10.1681/ASN.2015070763
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More in this TOC Section

  • Racial Differences in AKI Incidence Following Percutaneous Coronary Intervention
  • Two-Week Burden of Arrhythmias across CKD Severity in a Large Community-Based Cohort: The ARIC Study
  • Effect of Kidney Function on Relationships between Lifestyle Behaviors and Mortality or Cardiovascular Outcomes: A Pooled Cohort Analysis
Show more Clinical Epidemiology

Cited By...

  • The Pathogenesis of Race and Ethnic Disparities: Targets for Achieving Health Equity
  • Initial Validation of a Machine Learning-Derived Prognostic Test (KidneyIntelX) Integrating Biomarkers and Electronic Health Record Data To Predict Longitudinal Kidney Outcomes
  • Kidney Disease, Race, and GFR Estimation
  • Apolipoprotein L1 Gene Testing Comes of Age
  • APOL1 Kidney Risk Variants and Cardiovascular Disease: An Individual Participant Data Meta-Analysis
  • Prediction of rapid kidney function decline using machine learning combining blood biomarkers and electronic health record data
  • Diabetes and Trajectories of Estimated Glomerular Filtration Rate: A Prospective Cohort Analysis of the Atherosclerosis Risk in Communities Study
  • Soluble Urokinase-Type Plasminogen Activator Receptor in Black Americans with CKD
  • APOL1 Nephropathy Risk Variants and Incident Cardiovascular Disease Events in Community-Dwelling Black Adults
  • APOL1 Sends Its REGARDS to Cardiovascular Disease
  • 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines
  • 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines
  • HDL in CKD--The Devil Is in the Detail
  • APOL1 Genotype and Renal Function of Black Living Donors
  • Association Between APOL1 Genotypes and Risk of Cardiovascular Disease in MESA (Multi-Ethnic Study of Atherosclerosis)
  • APOL1 Risk Variants, Incident Proteinuria, and Subsequent eGFR Decline in Blacks with Hypertension-Attributed CKD
  • APOL1 Risk Variants and Cardiovascular Disease: Results From the AASK (African American Study of Kidney Disease and Hypertension)
  • APOL1 and Cardiovascular Disease: A Story in Evolution
  • Sickle Cell Trait and the Risk of ESRD in Blacks
  • Patterns of Kidney Function Decline Associated with APOL1 Genotypes: Results from AASK
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Keywords

  • end-stage renal disease
  • glomerular filtration rate
  • ethnicity

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