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Flack JM, Agarwal R, Anker SD, Pitt B, Ruilope LM, Rossing P, Adler SG, Fried L, Jamerson K, Toto R, Brinker M, Farjat AE, Kolkhof P, Lawatscheck R, Joseph A, Bakris GL. Finerenone in Black Patients With Type 2 Diabetes and CKD: A Post hoc Analysis of the Pooled FIDELIO-DKD and FIGARO-DKD Trials. Kidney Med 2023; 5:100730. [PMID: 38046911 PMCID: PMC10692708 DOI: 10.1016/j.xkme.2023.100730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2023] Open
Abstract
Rationale & Objective In FIDELITY, finerenone improved cardiorenal outcomes in patients with chronic kidney disease (CKD) and type 2 diabetes (T2D). This analysis explored the efficacy and safety of finerenone in Black patients. Study Design Subanalysis of randomized controlled trials. Setting & Participants Patients with T2D and CKD. Intervention Finerenone or placebo. Outcomes Composite of cardiovascular death, nonfatal myocardial infarction, nonfatal stroke, or hospitalization for heart failure; composite of kidney failure, sustained ≥57% estimated glomerular filtration rate (eGFR) decline from baseline maintained for ≥4 weeks, or renal death. Results Of the 13,026 patients, 522 (4.0%) self-identified as Black. Finerenone demonstrated similar effects on the cardiovascular composite outcome in Black (HR, 0.79 [95% CI, 0.51-1.24]) and non-Black patients (HR, 0.87 [95% CI, 0.79-0.96; P = 0.5 for interaction]). Kidney composite outcomes were consistent in Black (HR, 0.71 [95% CI, 0.43-1.16]) and non-Black patients (HR, 0.76 [95% CI, 0.66-0.88; P = 0.9 for interaction]). Finerenone reduced urine albumin-to-creatinine ratio by 40% at month 4 (least-squares mean treatment ratio, 0.60 [95% CI, 0.52-0.69; P < 0.001]) in Black patients and 32% at month 4 (least-squares mean treatment ratio, 0.68 [95% CI, 0.66-0.70; P < 0.001]) in non-Black patients, versus placebo. Chronic eGFR decline (month 4 to end-of-study) was slowed in Black and non-Black patients treated with finerenone versus placebo (between-group difference, 1.4 mL/min/1.73 m2 per year [95% CI, 0.33-2.44; P = 0.01] and 1.1 mL/min/1.73 m2 per year [95% CI, 0.89-1.28; P < 0.001], respectively). Safety outcomes were similar between subgroups. Limitations Small number of Black patients; analysis was not originally powered to determine an interaction effect based on Black race. Conclusions The efficacy and safety of finerenone appears consistent in Black and non-Black patients with CKD and T2D. Funding Bayer AG. Trial Registration ClinicalTrials.gov NCT02540993, NCT02545049. Plain-Language Summary Diabetes is a major cause of chronic kidney disease (CKD), affecting more Black adults than White adults. Most adults with CKD ultimately die from heart and vascular complications (eg, heart attack and stroke) rather than kidney failure. This analysis of 2 recent trials shows that the drug finerenone was beneficial for patients with diabetes and CKD. Along with reducing kidney function decline and protein in the urine, it also decreased heart and vascular issues and lowered blood pressure in both Black and non-Black adults with diabetes and CKD. These findings have promising implications for slowing the progression of CKD and protecting against cardiovascular problems in diverse populations.
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Affiliation(s)
- John M. Flack
- Department of Medicine, Division of General Internal Medicine, Hypertension Section Southern Illinois University School of Medicine, Illinois, IL
| | - Rajiv Agarwal
- Richard L. Roudebush VA Medical Center and Indiana University, Indianapolis, IN
| | - Stefan D. Anker
- Department of Cardiology (CVK) of German Heart Center Charité; Institute of Health Center for Regenerative Therapies (BCRT), German Centre for Cardiovascular Research (DZHK) partner site Berlin, Charité Universitätsmedizin, Berlin, Germany
| | - Bertram Pitt
- Department of Medicine, University of Michigan School of Medicine, Ann Arbor, MI
| | - Luis M. Ruilope
- Cardiorenal Translational Laboratory and Hypertension Unit, Institute of Research imas12, Madrid, Spain
- CIBER-CV, Hospital Universitario 12 de Octubre, Madrid, Spain
- Faculty of Sport Sciences, European University of Madrid, Madrid, Spain
| | - Peter Rossing
- Steno Diabetes Center Copenhagen, Gentofte, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Sharon G. Adler
- Division of Nephrology and Hypertension, Harbor-UCLA Medical Center, Torrance, CA
| | - Linda Fried
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Kenneth Jamerson
- Cardiology Clinic, University of Michigan, Ann Arbor, Michigan, MI
| | - Robert Toto
- Department of Internal Medicine, University of Texas Southwestern Medicine, Dallas, TX
| | - Meike Brinker
- Cardiology and Nephrology Clinical Development, Bayer AG, Wuppertal, Germany
| | - Alfredo E. Farjat
- Research and Development, Statistics and Data Insights, Bayer PLC, Reading, United Kingdom
| | - Peter Kolkhof
- Research and Development Cardiovascular Precision Medicines, Bayer AG, Wuppertal, Germany
| | - Robert Lawatscheck
- Cardiology and Nephrology Clinical Development, Bayer AG, Berlin, Germany
| | - Amer Joseph
- Cardiology and Nephrology Clinical Development, Bayer AG, Berlin, Germany
| | - George L. Bakris
- Department of Medicine, University of Chicago Medicine, Chicago, IL
| | - FIDELIO-DKD and FIGARO-DKD Investigators
- Department of Medicine, Division of General Internal Medicine, Hypertension Section Southern Illinois University School of Medicine, Illinois, IL
- Richard L. Roudebush VA Medical Center and Indiana University, Indianapolis, IN
- Department of Cardiology (CVK) of German Heart Center Charité; Institute of Health Center for Regenerative Therapies (BCRT), German Centre for Cardiovascular Research (DZHK) partner site Berlin, Charité Universitätsmedizin, Berlin, Germany
- Department of Medicine, University of Michigan School of Medicine, Ann Arbor, MI
- Cardiorenal Translational Laboratory and Hypertension Unit, Institute of Research imas12, Madrid, Spain
- CIBER-CV, Hospital Universitario 12 de Octubre, Madrid, Spain
- Faculty of Sport Sciences, European University of Madrid, Madrid, Spain
- Steno Diabetes Center Copenhagen, Gentofte, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Division of Nephrology and Hypertension, Harbor-UCLA Medical Center, Torrance, CA
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA
- Cardiology Clinic, University of Michigan, Ann Arbor, Michigan, MI
- Department of Internal Medicine, University of Texas Southwestern Medicine, Dallas, TX
- Cardiology and Nephrology Clinical Development, Bayer AG, Wuppertal, Germany
- Research and Development, Statistics and Data Insights, Bayer PLC, Reading, United Kingdom
- Research and Development Cardiovascular Precision Medicines, Bayer AG, Wuppertal, Germany
- Cardiology and Nephrology Clinical Development, Bayer AG, Berlin, Germany
- Department of Medicine, University of Chicago Medicine, Chicago, IL
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Lentine KL, Muiru AN, Lindsay KK, Caliskan Y, Edwards JC, Memon AA, Mosman AK, Miyata KN, Vo TM, Freedman BI, Carriker A, Hsu CY, Philipneri MD. APOL1 Genetic Testing in Patients With Recent African Ancestry and Hypertension: A Pilot Study of Attitudes and Perceptions. Kidney Med 2022; 4:100549. [PMID: 36573119 PMCID: PMC9788954 DOI: 10.1016/j.xkme.2022.100549] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Affiliation(s)
- Krista L. Lentine
- SSM-Saint Louis University Hospital, St Louis, MO
- Address for Correspondence: Krista L. Lentine, MD, PhD, Saint Louis University Transplant Center, SSM-Saint Louis University Hospital, 1201 S Grand Blvd, St Louis, MO 63104
| | | | | | | | | | | | | | | | - Than-Mai Vo
- SSM-Saint Louis University Hospital, St Louis, MO
| | | | | | - Chi-yuan Hsu
- University of California, San Francisco, San Francisco, CA
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Eadon MT, Cavanaugh KL, Orlando LA, Christian D, Chakraborty H, Steen-Burrell KA, Merrill P, Seo J, Hauser D, Singh R, Beasley CM, Fuloria J, Kitzman H, Parker AS, Ramos M, Ong HH, Elwood EN, Lynch SE, Clermont S, Cicali EJ, Starostik P, Pratt VM, Nguyen KA, Rosenman MB, Calman NS, Robinson M, Nadkarni GN, Madden EB, Kucher N, Volpi S, Dexter PR, Skaar TC, Johnson JA, Cooper-DeHoff RM, Horowitz CR. Design and rationale of GUARDD-US: A pragmatic, randomized trial of genetic testing for APOL1 and pharmacogenomic predictors of antihypertensive efficacy in patients with hypertension. Contemp Clin Trials 2022; 119:106813. [PMID: 35660539 PMCID: PMC9928488 DOI: 10.1016/j.cct.2022.106813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 05/25/2022] [Accepted: 05/30/2022] [Indexed: 11/28/2022]
Abstract
RATIONALE AND OBJECTIVE APOL1 risk alleles are associated with increased cardiovascular and chronic kidney disease (CKD) risk. It is unknown whether knowledge of APOL1 risk status motivates patients and providers to attain recommended blood pressure (BP) targets to reduce cardiovascular disease. STUDY DESIGN Multicenter, pragmatic, randomized controlled clinical trial. SETTING AND PARTICIPANTS 6650 individuals with African ancestry and hypertension from 13 health systems. INTERVENTION APOL1 genotyping with clinical decision support (CDS) results are returned to participants and providers immediately (intervention) or at 6 months (control). A subset of participants are re-randomized to pharmacogenomic testing for relevant antihypertensive medications (pharmacogenomic sub-study). CDS alerts encourage appropriate CKD screening and antihypertensive agent use. OUTCOMES Blood pressure and surveys are assessed at baseline, 3 and 6 months. The primary outcome is change in systolic BP from enrollment to 3 months in individuals with two APOL1 risk alleles. Secondary outcomes include new diagnoses of CKD, systolic blood pressure at 6 months, diastolic BP, and survey results. The pharmacogenomic sub-study will evaluate the relationship of pharmacogenomic genotype and change in systolic BP between baseline and 3 months. RESULTS To date, the trial has enrolled 3423 participants. CONCLUSIONS The effect of patient and provider knowledge of APOL1 genotype on systolic blood pressure has not been well-studied. GUARDD-US addresses whether blood pressure improves when patients and providers have this information. GUARDD-US provides a CDS framework for primary care and specialty clinics to incorporate APOL1 genetic risk and pharmacogenomic prescribing in the electronic health record. TRIAL REGISTRATION ClinicalTrials.govNCT04191824.
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Affiliation(s)
- Michael T Eadon
- Indiana University School of Medicine, Indianapolis, IN 46202, USA
| | | | - Lori A Orlando
- Duke University School of Medicine, Durham, NC 27720, USA
| | - David Christian
- Institute for Health Equity Research, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Hrishikesh Chakraborty
- Duke University School of Medicine, Durham, NC 27720, USA; Duke Clinical Research Institute, Durham, NC 27720, USA
| | | | - Peter Merrill
- Duke Clinical Research Institute, Durham, NC 27720, USA
| | - Janet Seo
- Institute for Health Equity Research, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Diane Hauser
- Institute for Health Equity Research, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; Institute for Family Health, New York, NY 10029, USA
| | - Rajbir Singh
- Meharry Medical College, Nashville, TN 37208, USA
| | - Cherry Maynor Beasley
- McKenzie-Elliott School of Nursing, University of North Carolina at Pembroke, Pembroke, NC 28372, USA
| | - Jyotsna Fuloria
- Office of Research, University Medical Center New Orleans, New Orleans, LA 70112, USA
| | - Heather Kitzman
- Baylor Scott & White Health, Baylor University, Robbins Institute for Health Policy & Leadership, Dallas, TX 75246, USA
| | - Alexander S Parker
- University of Florida College of Medicine - Jacksonville, Jacksonville, FL 32209, USA
| | - Michelle Ramos
- Institute for Health Equity Research, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Henry H Ong
- Vanderbilt University Medical Center, Nashville, TN 37232, USA
| | - Erica N Elwood
- University of Florida, College of Pharmacy, Gainesville, FL 32610, USA
| | - Sheryl E Lynch
- Indiana University School of Medicine, Indianapolis, IN 46202, USA
| | - Sabrina Clermont
- Institute for Health Equity Research, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Emily J Cicali
- University of Florida, College of Pharmacy, Gainesville, FL 32610, USA
| | - Petr Starostik
- University of Florida, College of Medicine, Gainesville, FL 32610, USA
| | - Victoria M Pratt
- Indiana University School of Medicine, Indianapolis, IN 46202, USA
| | - Khoa A Nguyen
- University of Florida, College of Pharmacy, Gainesville, FL 32610, USA
| | - Marc B Rosenman
- Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA
| | - Neil S Calman
- Institute for Health Equity Research, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; Institute for Family Health, New York, NY 10029, USA
| | | | - Girish N Nadkarni
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Ebony B Madden
- Division of Genomic Medicine, National Human Genome Research Institute, Bethesda, MD 20892, USA
| | - Natalie Kucher
- Division of Genomic Medicine, National Human Genome Research Institute, Bethesda, MD 20892, USA
| | - Simona Volpi
- Division of Genomic Medicine, National Human Genome Research Institute, Bethesda, MD 20892, USA
| | - Paul R Dexter
- Indiana University School of Medicine, Indianapolis, IN 46202, USA
| | - Todd C Skaar
- Indiana University School of Medicine, Indianapolis, IN 46202, USA
| | - Julie A Johnson
- University of Florida, College of Pharmacy, Gainesville, FL 32610, USA
| | | | - Carol R Horowitz
- Institute for Health Equity Research, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA.
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Nadkarni GN, Fei K, Ramos MA, Hauser D, Bagiella E, Ellis SB, Sanderson S, Scott SA, Sabin T, Madden E, Cooper R, Pollak M, Calman N, Bottinger EP, Horowitz CR. Effects of Testing and Disclosing Ancestry-Specific Genetic Risk for Kidney Failure on Patients and Health Care Professionals: A Randomized Clinical Trial. JAMA Netw Open 2022; 5:e221048. [PMID: 35244702 PMCID: PMC8897752 DOI: 10.1001/jamanetworkopen.2022.1048] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
IMPORTANCE Risk variants in the apolipoprotein L1 (APOL1 [OMIM 603743]) gene on chromosome 22 are common in individuals of West African ancestry and confer increased risk of kidney failure for people with African ancestry and hypertension. Whether disclosing APOL1 genetic testing results to patients of African ancestry and their clinicians affects blood pressure, kidney disease screening, or patient behaviors is unknown. OBJECTIVE To determine the effects of testing and disclosing APOL1 genetic results to patients of African ancestry with hypertension and their clinicians. DESIGN, SETTING, AND PARTICIPANTS This pragmatic randomized clinical trial randomly assigned 2050 adults of African ancestry with hypertension and without existing chronic kidney disease in 2 US health care systems from November 1, 2014, through November 28, 2016; the final date of follow-up was January 16, 2018. Patients were randomly assigned to undergo immediate (intervention) or delayed (waiting list control group) APOL1 testing in a 7:1 ratio. Statistical analysis was performed from May 1, 2018, to July 31, 2020. INTERVENTIONS Patients randomly assigned to the intervention group received APOL1 genetic testing results from trained staff; their clinicians received results through clinical decision support in electronic health records. Waiting list control patients received the results after their 12-month follow-up visit. MAIN OUTCOMES AND MEASURES Coprimary outcomes were the change in 3-month systolic blood pressure and 12-month urine kidney disease screening comparing intervention patients with high-risk APOL1 genotypes and those with low-risk APOL1 genotypes. Secondary outcomes compared these outcomes between intervention group patients with high-risk APOL1 genotypes and controls. Exploratory analyses included psychobehavioral factors. RESULTS Among 2050 randomly assigned patients (1360 women [66%]; mean [SD] age, 53 [10] years), the baseline mean (SD) systolic blood pressure was significantly higher in patients with high-risk APOL1 genotypes vs those with low-risk APOL1 genotypes and controls (137 [21] vs 134 [19] vs 133 [19] mm Hg; P = .003 for high-risk vs low-risk APOL1 genotypes; P = .001 for high-risk APOL1 genotypes vs controls). At 3 months, the mean (SD) change in systolic blood pressure was significantly greater in patients with high-risk APOL1 genotypes vs those with low-risk APOL1 genotypes (6 [18] vs 3 [18] mm Hg; P = .004) and controls (6 [18] vs 3 [19] mm Hg; P = .01). At 12 months, there was a 12% increase in urine kidney disease testing among patients with high-risk APOL1 genotypes (from 39 of 234 [17%] to 68 of 234 [29%]) vs a 6% increase among those with low-risk APOL1 genotypes (from 278 of 1561 [18%] to 377 of 1561 [24%]; P = .10) and a 7% increase among controls (from 33 of 255 [13%] to 50 of 255 [20%]; P = .01). In response to testing, patients with high-risk APOL1 genotypes reported more changes in lifestyle (a subjective measure that included better dietary and exercise habits; 129 of 218 [59%] vs 547 of 1468 [37%]; P < .001) and increased blood pressure medication use (21 of 218 [10%] vs 68 of 1468 [5%]; P = .005) vs those with low-risk APOL1 genotypes; 1631 of 1686 (97%) declared they would get tested again. CONCLUSIONS AND RELEVANCE In this randomized clinical trial, disclosing APOL1 genetic testing results to patients of African ancestry with hypertension and their clinicians was associated with a greater reduction in systolic blood pressure, increased kidney disease screening, and positive self-reported behavior changes in those with high-risk genotypes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02234063.
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Affiliation(s)
- Girish N. Nadkarni
- Division of Nephrology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
- The Charles Bronfman Institute for Personalized Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Kezhen Fei
- Department of Population Health Sciences and Policy, Icahn School of Medicine at Mount Sinai, New York, New York
- Institute for Health Equity Research, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Michelle A. Ramos
- Department of Population Health Sciences and Policy, Icahn School of Medicine at Mount Sinai, New York, New York
- Institute for Health Equity Research, Icahn School of Medicine at Mount Sinai, New York, New York
| | | | - Emilia Bagiella
- Department of Population Health Sciences and Policy, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Stephen B. Ellis
- The Charles Bronfman Institute for Personalized Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Saskia Sanderson
- The Charles Bronfman Institute for Personalized Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Stuart A. Scott
- The Charles Bronfman Institute for Personalized Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, New York
- Sema4, A Mount Sinai Venture, Stamford, Connecticut
| | - Tatiana Sabin
- Department of Population Health Sciences and Policy, Icahn School of Medicine at Mount Sinai, New York, New York
- Institute for Health Equity Research, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Ebony Madden
- National Human Genome Research Institute, Bethesda, Maryland
| | - Richard Cooper
- Department of Public Health Sciences, Loyola University Medical School, Maywood, Illinois
| | - Martin Pollak
- Division of Nephrology, Harvard Medical School, Boston, Massachusetts
| | - Neil Calman
- Institute for Health Equity Research, Icahn School of Medicine at Mount Sinai, New York, New York
- Institute for Family Health, New York, New York
| | - Erwin P. Bottinger
- Division of Nephrology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
- The Charles Bronfman Institute for Personalized Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
- Digital Health Center, Hasso Plattner Institute, Potsdam, Germany
| | - Carol R. Horowitz
- The Charles Bronfman Institute for Personalized Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
- Department of Population Health Sciences and Policy, Icahn School of Medicine at Mount Sinai, New York, New York
- Institute for Health Equity Research, Icahn School of Medicine at Mount Sinai, New York, New York
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Atutornu J, Milne R, Costa A, Patch C, Middleton A. Towards equitable and trustworthy genomics research. EBioMedicine 2022; 76:103879. [PMID: 35158310 PMCID: PMC8850759 DOI: 10.1016/j.ebiom.2022.103879] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 01/04/2022] [Accepted: 01/28/2022] [Indexed: 12/11/2022] Open
Abstract
The representation of traditionally scientifically underserved groups in genomic research continues to be low despite concerns about equity and social justice and the scientific and clinical need. Among the factors that account for this are a lack of trust in the research community and limited diversity in this community. The success of the multiple initiatives that aim to improve representation relies on the willingness of underrepresented populations to make data and samples available for research and clinical use. In this narrative review, we propose that this requires building trust, and set out four approaches to demonstrating trustworthiness, including increasing diversity in the research workforce, and meaningful engagement with underrepresented communities in a culturally and linguistically appropriate manner. Capacity building globally will ensure that actual and perceived exploitation and ‘helicopter’ research could be eliminated.
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Affiliation(s)
- Jerome Atutornu
- Engagement and Society, Wellcome Connecting Science, Wellcome Genome Campus, Cambridge CB10 1SA, UK; School of Health and Sports Sciences, University of Suffolk, Ipswich, IP4 1QJ
| | - Richard Milne
- Engagement and Society, Wellcome Connecting Science, Wellcome Genome Campus, Cambridge CB10 1SA, UK; Kavli Centre for Ethics, Science and the Public, Faculty of Education, University of Cambridge, CB2 8PQ
| | - Alesia Costa
- Engagement and Society, Wellcome Connecting Science, Wellcome Genome Campus, Cambridge CB10 1SA, UK
| | - Christine Patch
- Engagement and Society, Wellcome Connecting Science, Wellcome Genome Campus, Cambridge CB10 1SA, UK
| | - Anna Middleton
- Engagement and Society, Wellcome Connecting Science, Wellcome Genome Campus, Cambridge CB10 1SA, UK; Kavli Centre for Ethics, Science and the Public, Faculty of Education, University of Cambridge, CB2 8PQ.
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Dinh A, Copeland T, Freedman BI, McCulloch CE, Ku E. Intensive Blood Pressure Control, APOL1 Genotype, and Kidney Outcomes in Individuals With Type 2 Diabetes: A Post Hoc Analysis of the Action to Control Cardiovascular Risk in Diabetes-Blood Pressure (ACCORD-BP) Trial. Kidney Med 2021; 3:874-876. [PMID: 34693269 PMCID: PMC8515080 DOI: 10.1016/j.xkme.2021.04.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Affiliation(s)
- Alex Dinh
- Division of Nephrology, Department of Medicine, University of California, San Francisco, San Francisco, California
| | - Timothy Copeland
- Division of Nephrology, Department of Medicine, University of California, San Francisco, San Francisco, California
| | - Barry I Freedman
- Department of Internal Medicine, Section on Nephrology, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Charles E McCulloch
- Department of Epidemiology & Biostatistics, University of California, San Francisco, San Francisco, California
| | - Elaine Ku
- Division of Nephrology, Department of Medicine, University of California, San Francisco, San Francisco, California.,Department of Epidemiology & Biostatistics, University of California, San Francisco, San Francisco, California.,Division of Pediatric Nephrology, Department of Pediatrics, University of California, San Francisco, San Francisco, California
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Freedman BI, Burke W, Divers J, Eberhard L, Gadegbeku CA, Gbadegesin R, Hall ME, Jones-Smith T, Knight R, Kopp JB, Kovesdy CP, Norris KC, Olabisi OA, Roberts GV, Sedor JR, Blacksher E. Diagnosis, Education, and Care of Patients with APOL1-Associated Nephropathy: A Delphi Consensus and Systematic Review. J Am Soc Nephrol 2021; 32:1765-1778. [PMID: 33853887 PMCID: PMC8425659 DOI: 10.1681/asn.2020101399] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Accepted: 02/12/2021] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND APOL1 variants contribute to the markedly higher incidence of ESKD in Blacks compared with Whites. Genetic testing for these variants in patients with African ancestry who have nephropathy is uncommon, and no specific treatment or management protocol for APOL1-associated nephropathy currently exists. METHODS A multidisciplinary, racially diverse group of 14 experts and patient advocates participated in a Delphi consensus process to establish practical guidance for clinicians caring for patients who may have APOL1-associated nephropathy. Consensus group members took part in three anonymous voting rounds to develop consensus statements relating to the following: (1) counseling, genotyping, and diagnosis; (2) disease awareness and education; and (3) a vision for management of APOL1-associated nephropathy in a future when treatment is available. A systematic literature search of the MEDLINE and Embase databases was conducted to identify relevant evidence published from January 1, 2009 to July 14, 2020. RESULTS The consensus group agreed on 55 consensus statements covering such topics as demographic and clinical factors that suggest a patient has APOL1-associated nephropathy, as well as key considerations for counseling, testing, and diagnosis in current clinical practice. They achieved consensus on the need to increase awareness among key stakeholders of racial health disparities in kidney disease and of APOL1-associated nephropathy and on features of a successful education program to raise awareness among the patient community. The group also highlighted the unmet need for a specific treatment and agreed on best practice for management of these patients should a treatment become available. CONCLUSIONS A multidisciplinary group of experts and patient advocates defined consensus-based guidance on the care of patients who may have APOL1-associated nephropathy.
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Affiliation(s)
- Barry I. Freedman
- Department of Internal Medicine, Section on Nephrology, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Wylie Burke
- Department of Bioethics and Humanities, University of Washington, Seattle, Washington
| | - Jasmin Divers
- Division of Health Services Research, Department of Foundations of Medicine, New York University Long Island School of Medicine and Winthrop Research Institute, Mineola, New York
| | | | - Crystal A. Gadegbeku
- Department of Medicine, Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania
| | - Rasheed Gbadegesin
- Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina
| | - Michael E. Hall
- Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi
| | | | | | - Jeffrey B. Kopp
- Kidney Disease Section, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland
| | - Csaba P. Kovesdy
- Division of Nephrology, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Keith C. Norris
- Division of General Internal Medicine and Health Services Research, University of California Los Angeles Medical Center, University of California, Los Angeles, California
| | - Opeyemi A. Olabisi
- Department of Medicine, Duke Molecular Physiology Institute, Durham, North Carolina
| | - Glenda V. Roberts
- Kidney Research Institute/Center for Dialysis Innovation, University of Washington, Seattle, Washington
| | - John R. Sedor
- Department of Nephrology and Hypertension, Glickman Urology and Kidney Institute, Cleveland Clinic, Cleveland, Ohio
- Department of Immunology and Inflammation, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio
| | - Erika Blacksher
- Department of Bioethics and Humanities, University of Washington, Seattle, Washington
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Schneider TM, Eadon MT, Cooper-DeHoff RM, Cavanaugh KL, Nguyen KA, Arwood MJ, Tillman EM, Pratt VM, Dexter PR, McCoy AB, Orlando LA, Scott SA, Nadkarni GN, Horowitz CR, Kannry JL. Multi-Institutional Implementation of Clinical Decision Support for APOL1, NAT2, and YEATS4 Genotyping in Antihypertensive Management. J Pers Med 2021; 11:jpm11060480. [PMID: 34071920 PMCID: PMC8226809 DOI: 10.3390/jpm11060480] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 05/21/2021] [Accepted: 05/25/2021] [Indexed: 01/13/2023] Open
Abstract
(1) Background: Clinical decision support (CDS) is a vitally important adjunct to the implementation of pharmacogenomic-guided prescribing in clinical practice. A novel CDS was sought for the APOL1, NAT2, and YEATS4 genes to guide optimal selection of antihypertensive medications among the African American population cared for at multiple participating institutions in a clinical trial. (2) Methods: The CDS committee, made up of clinical content and CDS experts, developed a framework and contributed to the creation of the CDS using the following guiding principles: 1. medical algorithm consensus; 2. actionability; 3. context-sensitive triggers; 4. workflow integration; 5. feasibility; 6. interpretability; 7. portability; and 8. discrete reporting of lab results. (3) Results: Utilizing the principle of discrete patient laboratory and vital information, a novel CDS for APOL1, NAT2, and YEATS4 was created for use in a multi-institutional trial based on a medical algorithm consensus. The alerts are actionable and easily interpretable, clearly displaying the purpose and recommendations with pertinent laboratory results, vitals and links to ordersets with suggested antihypertensive dosages. Alerts were either triggered immediately once a provider starts to order relevant antihypertensive agents or strategically placed in workflow-appropriate general CDS sections in the electronic health record (EHR). Detailed implementation instructions were shared across institutions to achieve maximum portability. (4) Conclusions: Using sound principles, the created genetic algorithms were applied across multiple institutions. The framework outlined in this study should apply to other disease-gene and pharmacogenomic projects employing CDS.
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Affiliation(s)
- Thomas M. Schneider
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; (C.R.H.); (J.L.K.)
- Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
- Correspondence:
| | - Michael T. Eadon
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN 46202, USA; (M.T.E.); (E.M.T.); (P.R.D.)
| | - Rhonda M. Cooper-DeHoff
- Center for Pharmacogenetics and Precision Medicine and Department of Pharmacotherapy and Translational Research, College of Pharmacy, University of Florida Gainesville, Gainesville, FL 32610, USA; (R.M.C.-D.); (K.A.N.); (M.J.A.)
- Division of Cardiovascular Medicine, College of Medicine, University of Florida, Gainesville, FL 32610, USA
| | - Kerri L. Cavanaugh
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN 37232, USA;
| | - Khoa A. Nguyen
- Center for Pharmacogenetics and Precision Medicine and Department of Pharmacotherapy and Translational Research, College of Pharmacy, University of Florida Gainesville, Gainesville, FL 32610, USA; (R.M.C.-D.); (K.A.N.); (M.J.A.)
| | - Meghan J. Arwood
- Center for Pharmacogenetics and Precision Medicine and Department of Pharmacotherapy and Translational Research, College of Pharmacy, University of Florida Gainesville, Gainesville, FL 32610, USA; (R.M.C.-D.); (K.A.N.); (M.J.A.)
| | - Emma M. Tillman
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN 46202, USA; (M.T.E.); (E.M.T.); (P.R.D.)
| | - Victoria M. Pratt
- Department of Medical and Molecular Genetics, Indiana University School of Medicine, Indianapolis, IN 46202, USA;
| | - Paul R. Dexter
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN 46202, USA; (M.T.E.); (E.M.T.); (P.R.D.)
| | - Allison B. McCoy
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN 37232, USA;
| | - Lori A. Orlando
- Center for Applied Genomics & Precision Medicine, Duke University School of Medicine, 101 Science Drive, Box 3382, Durham, NC 27708, USA;
| | - Stuart A. Scott
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA;
| | - Girish N. Nadkarni
- Department of Nephrology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA;
| | - Carol R. Horowitz
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; (C.R.H.); (J.L.K.)
- Department of Population Health Sciences, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Joseph L. Kannry
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; (C.R.H.); (J.L.K.)
- Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
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West KM, Blacksher E, Cavanaugh KL, Fullerton SM, Umeukeje EM, Young BA, Burke W. At the Research-Clinical Interface: Returning Individual Genetic Results to Research Participants. Clin J Am Soc Nephrol 2020; 15:1181-1189. [PMID: 32041801 PMCID: PMC7409748 DOI: 10.2215/cjn.09670819] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Whether individual results of genetic research studies ought to be disclosed to study participants has been debated in recent decades. Previously, the prevailing expert view discouraged the return of individual research results to participants because of the potential lack of analytic validity, questionable clinical validity and medical actionability, and questions about whether it is the role of research to provide participants with their data. With additional knowledge of participant perspectives and shifting views about the benefits of research and respect for participants, current expert consensus is moving toward support of returning such results. Significant ethical controversies remain, and there are many practical questions left to address, including appropriate procedures for returning results and the potential burden to clinicians when patients seek guidance about the clinical implications of research results. In this review, we describe current views regarding the return of genetic research results, including controversies and practical challenges, and consider the application of these issues to research on apolipoprotein L1 (APOL1), a gene recently associated with health disparities in kidney disease. Although this case is unique, it illustrates the complexities involved in returning results and highlights remaining questions.
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Affiliation(s)
| | | | - Kerri L Cavanaugh
- Division of Nephrology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | | | - Ebele M Umeukeje
- Division of Nephrology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Bessie A Young
- Department of Medicine, Veterans Affairs Puget Sound Health Care System, Seattle, Washington.,Division of Nephrology, University of Washington, Seattle, Washington; and.,Kidney Research Institute, University of Washington, Seattle, Washington
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Wei J, Johansen KL, McCulloch CE, Lipkowitz M, Weir M, Lin F, Campese VM, Smogorzewski M, Ku E. Association Between APOL1 Genotype and Need for Kidney Replacement Therapy in Patients Without Diabetes: Does Age Matter? Am J Kidney Dis 2019; 75:294-296. [PMID: 31837887 DOI: 10.1053/j.ajkd.2019.08.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2019] [Accepted: 08/02/2019] [Indexed: 01/13/2023]
Affiliation(s)
- Jenny Wei
- Keck School of Medicine and Division of Nephrology, University of Southern California, Los Angeles, CA
| | - Kirsten L Johansen
- Division of Nephrology, Hennepin County Medical Center; Division of Nephrology, Hennepin Healthcare and University of Minnesota, Minneapolis, MN
| | - Charles E McCulloch
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA
| | - Michael Lipkowitz
- Division of Nephrology, Department of Medicine, Georgetown University, Washington, DC
| | - Matthew Weir
- Division of Nephrology, Department of Medicine, University of Maryland, Baltimore, MD
| | - Feng Lin
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA
| | - Vito M Campese
- Keck School of Medicine and Division of Nephrology, University of Southern California, Los Angeles, CA
| | - Miroslaw Smogorzewski
- Keck School of Medicine and Division of Nephrology, University of Southern California, Los Angeles, CA
| | - Elaine Ku
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA; Division of Nephrology, Department of Medicine and Pediatrics, University of California San Francisco, San Francisco, CA; Division of Pediatric Nephrology, Department of Medicine and Pediatrics, University of California San Francisco, San Francisco, CA.
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11
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Cunningham PN, Wang Z, Grove ML, Cooper-DeHoff RM, Beitelshees AL, Gong Y, Gums JG, Johnson JA, Turner ST, Boerwinkle E, Chapman AB. Hypertensive APOL1 risk allele carriers demonstrate greater blood pressure reduction with angiotensin receptor blockade compared to low risk carriers. PLoS One 2019; 14:e0221957. [PMID: 31532792 PMCID: PMC6750571 DOI: 10.1371/journal.pone.0221957] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Accepted: 08/19/2019] [Indexed: 12/12/2022] Open
Abstract
Background Hypertension (HTN) disproportionately affects African Americans (AAs), who respond better to thiazide diuretics than other antihypertensives. Variants of the APOL1 gene found in AAs are associated with a higher rate of kidney disease and play a complex role in cardiovascular disease. Methods AA subjects from four HTN trials (n = 961) (GERA1, GERA2, PEAR1, and PEAR2) were evaluated for blood pressure (BP) response based on APOL1 genotype after 4–9 weeks of monotherapy with thiazides, beta blockers, or candesartan. APOL1 G1 and G2 variants were determined by direct sequencing or imputation. Results Baseline systolic BP (SBP) and diastolic BP (DBP) levels did not differ based on APOL1 genotype. Subjects with 1–2 APOL1 risk alleles had a greater SBP response to candesartan (-12.2 +/- 1.2 vs -7.5 +/- 1.8 mmHg, p = 0.03; GERA2), and a greater decline in albuminuria with candesartan (-8.3 +/- 3.1 vs +3.7 +/- 4.3 mg/day, p = 0.02). APOL1 genotype did not associate with BP response to thiazides or beta blockers. GWAS was performed to determine associations with BP response to candesartan depending on APOL1 genotype. While no SNPs reached genome wide significance, SNP rs10113352, intronic in CSMD1, predicted greater office SBP response to candesartan (p = 3.7 x 10−7) in those with 1–2 risk alleles, while SNP rs286856, intronic in DPP6, predicted greater office SBP response (p = 3.2 x 10−7) in those with 0 risk alleles. Conclusions Hypertensive AAs without overt kidney disease who carry 1 or more APOL1 risk variants have a greater BP and albuminuria reduction in response to candesartan therapy. BP response to thiazides or beta blockers did not differ by APOL1 genotype. Future studies confirming this initial finding in an independent cohort are required.
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Affiliation(s)
- Patrick N. Cunningham
- Section of Nephrology, University of Chicago, Chicago, Illinois, United States of America
- * E-mail:
| | - Zhiying Wang
- Human Genetics Center, Department of Epidemiology, Human Genetics and Environmental Sciences, School of Public Health, The University of Texas Health Science Center at Houston, Houston, Texas, United States of America
| | - Megan L. Grove
- Human Genetics Center, Department of Epidemiology, Human Genetics and Environmental Sciences, School of Public Health, The University of Texas Health Science Center at Houston, Houston, Texas, United States of America
| | - Rhonda M. Cooper-DeHoff
- Department of Pharmacotherapy and Translational Research, College of Pharmacy and Division of Cardiovascular Medicine, College of Medicine, University of Florida, Gainesville, Florida, United States of America
| | - Amber L. Beitelshees
- Endocrinology, Diabetes, and Nutrition Division, Department of Medicine, University of Maryland, Baltimore, Maryland, United States of America
| | - Yan Gong
- Department of Pharmacotherapy and Translational Research, College of Pharmacy and Division of Cardiovascular Medicine, College of Medicine, University of Florida, Gainesville, Florida, United States of America
| | - John G. Gums
- Department of Pharmacotherapy and Translational Research, College of Pharmacy and Division of Cardiovascular Medicine, College of Medicine, University of Florida, Gainesville, Florida, United States of America
| | - Julie A. Johnson
- Department of Pharmacotherapy and Translational Research, College of Pharmacy and Division of Cardiovascular Medicine, College of Medicine, University of Florida, Gainesville, Florida, United States of America
| | - Stephen T. Turner
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Eric Boerwinkle
- Human Genetics Center, Department of Epidemiology, Human Genetics and Environmental Sciences, School of Public Health, The University of Texas Health Science Center at Houston, Houston, Texas, United States of America
- Baylor College of Medicine, Human Genome Sequencing Center, Houston, Texas, United States of America
| | - Arlene B. Chapman
- Section of Nephrology, University of Chicago, Chicago, Illinois, United States of America
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12
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Young BA, Blacksher E, Cavanaugh KL, Freedman BI, Fullerton SM, Kopp JB, Umeukeje EM, West KM, Wilson JG, Burke W. Apolipoprotein L1 Testing in African Americans: Involving the Community in Policy Discussions. Am J Nephrol 2019; 50:303-311. [PMID: 31480040 DOI: 10.1159/000502675] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Accepted: 08/13/2019] [Indexed: 01/13/2023]
Abstract
BACKGROUND Apolipoprotein A1 (APOL1) gene variants occurring in people of West African descent contribute to the greater burden of kidney disease among African Americans. These variants are associated with increased risk of nondiabetic nephropathy, more rapid progression of chronic kidney disease, and shorter survival of donor kidneys after transplantation. However, only a minority of people with APOL1-associated risk develops kidney disease and specific clinical measures to address APOL1-associated risk are lacking. Given these uncertainties, we sought to engage members of the African American public in discussions with other stakeholders about the appropriate use of APOL1 testing. METHODS Formative interviews with community members, researchers, and clinicians in Seattle WA, Nashville TN, and Jackson MS, provided baseline information about views toward APOL1 testing and informed the design of 3 community-based deliberations among African Americans. A national meeting held in March 2018 included 13 community members, 7 scientific advisors and 26 additional researchers, clinicians, bioethicists, patient advocates, and representatives from professional organizations and federal funding agencies. Using small break-out and plenary discussion, the group agreed on recommendations based on current knowledge about APOL1-associated risk. RESULTS Meeting outcomes included recommendations to develop educational materials about APOL1 for community members and clinicians; to offer APOL1 research results to participants; and on the use of APOL1testing in kidney transplant programs. The group recommended against the routine offer of APOL1 testing in clinical care. Areas of disagreement included whether kidney transplant programs should require APOL1 testing of prospective living donors or bar individuals with APOL1 risk from donating kidneys and whether testing should be available on request in routine clinical care. CONCLUSION We recommend continued discussion among stakeholders and concerted efforts to ensure active and informed participation of members of the affected community to guide research on APOL1 and kidney disease.
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Affiliation(s)
- Bessie A Young
- Department of Medicine, VA Puget Sound Health Care System, Division of Nephrology, and Kidney Research Institute, University of Washington, Seattle, Washington, USA
| | - Erika Blacksher
- Department of Bioethics and Humanities, University of Washington, Seattle, Washington, USA
| | - Kerri L Cavanaugh
- Division of Nephrology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Barry I Freedman
- Department of Internal Medicine, Section on Nephrology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Stephanie M Fullerton
- Department of Bioethics and Humanities, University of Washington, Seattle, Washington, USA
| | - Jeffrey B Kopp
- Kidney Diseases Branch, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, Maryland, USA
| | - Ebele M Umeukeje
- Division of Nephrology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Kathleen M West
- Department of Bioethics and Humanities, University of Washington, Seattle, Washington, USA,
| | - James G Wilson
- Department of Physiology and Biophysics, University of Mississippi, Jackson, Mississippi, USA
| | - Wylie Burke
- Department of Bioethics and Humanities, University of Washington, Seattle, Washington, USA
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13
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Ku E, Hsu RK, Tuot DS, Bae SR, Lipkowitz MS, Smogorzewski MJ, Grimes BA, Weir MR. Magnitude of the Difference Between Clinic and Ambulatory Blood Pressures and Risk of Adverse Outcomes in Patients With Chronic Kidney Disease. J Am Heart Assoc 2019; 8:e011013. [PMID: 31014164 PMCID: PMC6512117 DOI: 10.1161/jaha.118.011013] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Background Obtaining 24-hour ambulatory blood pressure ( BP ) is recommended for the detection of masked or white-coat hypertension. Our objective was to determine whether the magnitude of the difference between ambulatory and clinic BP s has prognostic implications. Methods and Results We included 610 participants of the AASK (African American Study of Kidney Disease and Hypertension) Cohort Study who had clinic and ambulatory BPs performed in close proximity in time. We used Cox models to determine the association between the absolute systolic BP ( SBP ) difference between clinic and awake ambulatory BPs (primary predictor) and death and end-stage renal disease. Of 610 AASK Cohort Study participants, 200 (32.8%) died during a median follow-up of 9.9 years; 178 (29.2%) developed end-stage renal disease. There was a U-shaped association between the clinic and ambulatory SBP difference with risk of death, but not end-stage renal disease. A 5- to <10-mm Hg higher clinic versus awake SBP (white-coat effect) was associated with a trend toward higher (adjusted) mortality risk (adjusted hazard ratio, 1.84; 95% CI, 0.94-3.56) compared with a 0- to <5-mm Hg clinic-awake SBP difference (reference group). A ≥10-mm Hg clinic-awake SBP difference was associated with even higher mortality risk (adjusted hazard ratio, 2.31; 95% CI, 1.27-4.22). A ≥-5-mm Hg clinic-awake SBP difference was also associated with higher mortality (adjusted hazard ratio, 1.82; 95% CI, 1.05-3.15) compared with the reference group. Conclusions A U-shaped association exists between the magnitude of the difference between clinic and ambulatory SBP and mortality. Higher clinic versus ambulatory BPs (as in white-coat effect) may be associated with higher risk of death in black patients with chronic kidney disease.
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Affiliation(s)
- Elaine Ku
- 1 Division of Nephrology Department of Medicine University of California, San Francisco San Francisco CA.,2 Division of Pediatric Nephrology Department of Pediatrics University of California, San Francisco San Francisco CA
| | - Raymond K Hsu
- 1 Division of Nephrology Department of Medicine University of California, San Francisco San Francisco CA
| | - Delphine S Tuot
- 3 Division of Nephrology Department of Medicine University of California, San Francisco Zuckerberg San Francisco General Hospital San Francisco CA
| | - Se Ri Bae
- 1 Division of Nephrology Department of Medicine University of California, San Francisco San Francisco CA
| | - Michael S Lipkowitz
- 4 Division of Nephrology and Hypertension Department of Medicine Georgetown University Washington DC
| | - Miroslaw J Smogorzewski
- 5 Division of Nephrology and Hypertension Department of Medicine University of Southern California Los Angeles CA
| | - Barbara A Grimes
- 6 Department of Epidemiology and Biostatistics University of California, San Francisco San Francisco CA
| | - Matthew R Weir
- 7 Division of Nephrology Department of Medicine University of Maryland Baltimore MD
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14
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Umeukeje EM, Young BA, Fullerton SM, Cavanaugh K, Owens D, Wilson JG, Burke W, Blacksher E. You Are Just Now Telling Us About This? African American Perspectives of Testing for Genetic Susceptibility to Kidney Disease. J Am Soc Nephrol 2019; 30:526-530. [PMID: 30858224 DOI: 10.1681/asn.2018111091] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Affiliation(s)
- Ebele M Umeukeje
- Division of Nephrology and Hypertension, Vanderbilt University Medical Center, Nashville, Tennessee
| | | | - Stephanie M Fullerton
- Department of Bioethics and Humanities, University of Washington, Seattle, Washington; and
| | - Kerri Cavanaugh
- Division of Nephrology and Hypertension, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Delia Owens
- Division of Nephrology, Department of Medicine and
| | - James G Wilson
- Department of Physiology and Biophysics, University of Mississippi Medical Center, Jackson, Mississippi
| | - Wylie Burke
- Department of Bioethics and Humanities, University of Washington, Seattle, Washington; and
| | - Erika Blacksher
- Department of Bioethics and Humanities, University of Washington, Seattle, Washington; and
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15
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Sarfo FS, Mobula LM, Sarfo-Kantanka O, Adamu S, Plange-Rhule J, Ansong D, Gyamfi RA, Duah J, Abraham B, Ofori-Adjei D. Estimated glomerular filtration rate predicts incident stroke among Ghanaians with diabetes and hypertension. J Neurol Sci 2018; 396:140-147. [PMID: 30471633 PMCID: PMC6330840 DOI: 10.1016/j.jns.2018.11.017] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Revised: 11/10/2018] [Accepted: 11/14/2018] [Indexed: 02/07/2023]
Abstract
Background Sub-Saharan Africa is currently experiencing a high burden of both chronic kidney disease (CKD) and stroke as a result of a rapid rise in shared common vascular risk factors such as hypertension and diabetes mellitus. However, no previous study has prospectively explored independent associations between CKD and incident stroke occurrence among indigenous Africans. This study sought to fill this knowledge gap. Methods A prospective cohort study involving Ghanaians adults with hypertension or type II diabetes mellitus from 5 public hospitals. Patients were followed every 2 months in clinic for 18 months and assessed clinically for first ever stroke by physicians. Serum creatinine derived estimated glomerular filtration rates (eGFR) were determined at baseline for 2631 (81.7%) out of 3296 participants. We assessed associations between eGFR and incident stroke using a multivariate Cox Proportional Hazards regression model. Results Stroke incidence rates (95% CI) increased with decreasing eGFR categories of 89, 60–88, 30–59 and <29 ml/min corresponding to incidence rates of 7.58 (3.58–13.51), 14.45 (9.07–21.92), 29.43 (15.95–50.04) and 66.23 (16.85–180.20)/1000 person-years respectively. Adjusted hazard ratios (95%CI) for stroke occurrence according to eGFR were 1.42 (0.63–3.21) for eGFR of 60-89 ml/min, 1.88 (1.17–3.02) for 30-59 ml/min and 1.52 (0.93–2.43) for <30 ml/min compared with eGFR of >89 ml/min. Adjusted HR for stroke occurrence among patients with hypertension with eGFR<60 ml/min was 3.69 (1.49–9.13), p = .0047 and among those with diabetes was 1.50 (0.56–3.98), p = .42. Conclusion CKD is dose-dependently associated with occurrence of incident strokes among Ghanaians with hypertension and diabetes mellitus. Further studies are warranted to explore interventions that could attenuate the risk of stroke attributable to renal disease among patients with hypertension in SSA. We assessed association between incident stroke and estimated glomerular filtration rate. 2631 participants stroke-free Ghanaian adults with hypertension or diabetes were followed for 14 months. There were 45 incident strokes. Incident stroke risk independently increased with declining eGFR.
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Affiliation(s)
- Fred Stephen Sarfo
- Department of Medicine, Kwame Nkrumah University of Science & Technology, Kumasi, Ghana; Department of Medicine, Komfo Anokye Teaching Hospital, Kumasi, Ghana.
| | - Linda Meta Mobula
- Johns Hopkins University School of Medicine, Baltimore, MD, USA; Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Osei Sarfo-Kantanka
- Department of Medicine, Kwame Nkrumah University of Science & Technology, Kumasi, Ghana; Department of Medicine, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - Sheila Adamu
- Department of Medicine, Kwame Nkrumah University of Science & Technology, Kumasi, Ghana; Department of Medicine, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | | | - Daniel Ansong
- Department of Medicine, Kwame Nkrumah University of Science & Technology, Kumasi, Ghana; Department of Medicine, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | | | | | | | - David Ofori-Adjei
- Department of Medicine & Therapeutics, University of Ghana, School of Medicine and Dentistry, Accra, Ghana
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16
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Ku E, Ix JH, Jamerson K, Tangri N, Lin F, Gassman J, Smogorzewski M, Sarnak MJ. Acute Declines in Renal Function during Intensive BP Lowering and Long-Term Risk of Death. J Am Soc Nephrol 2018; 29:2401-2408. [PMID: 30006417 PMCID: PMC6115661 DOI: 10.1681/asn.2018040365] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2018] [Accepted: 06/06/2018] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND During intensive BP lowering, acute declines in renal function are common, thought to be hemodynamic, and potentially reversible. We previously showed that acute declines in renal function ≥20% during intensive BP lowering were associated with higher risk of ESRD. Here, we determined whether acute declines in renal function during intensive BP lowering were associated with mortality risk among 1660 participants of the African American Study of Kidney Disease and Hypertension and the Modification of Diet in Renal Disease Trial. METHODS We used Cox models to examine the association between percentage decline in eGFR (<5%, 5% to <20%, or ≥20%) between randomization and months 3-4 of the trials (period of therapy intensification) and death. RESULTS In adjusted analyses, compared with a <5% eGFR decline in the usual BP arm (reference), a 5% to <20% eGFR decline in the intensive BP arm was associated with a survival benefit (hazard ratio [HR], 0.77; 95% confidence interval [95% CI], 0.62 to 0.96), but a 5% to <20% eGFR decline in the usual BP arm was not (HR, 1.01; 95% CI, 0.81 to 1.26; P<0.05 for the interaction between intensive and usual BP arms for mortality risk). A ≥20% eGFR decline was not associated with risk of death in the intensive BP arm (HR, 1.18; 95% CI, 0.86 to 1.62), but it was associated with a higher risk of death in the usual BP arm (HR, 1.40; 95% CI, 1.04 to 1.89) compared with the reference group. CONCLUSIONS Intensive BP lowering was associated with a mortality benefit only if declines in eGFR were <20%.
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Affiliation(s)
- Elaine Ku
- Division of Nephrology, Department of Medicine,
- Division of Pediatric Nephrology, Department of Pediatrics, and
| | - Joachim H Ix
- Division of Nephrology, Department of Medicine, University of California, San Diego, La Jolla, California
- Nephrology Section, Veterans Affairs San Diego Healthcare System, San Diego, California
| | - Kenneth Jamerson
- Division of Cardiovascular Medicine, Department of Medicine, University of Michigan, Ann Arbor, Michigan
| | - Navdeep Tangri
- Division of Nephrology, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Feng Lin
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California
| | - Jennifer Gassman
- Division of Quantitative Sciences, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Miroslaw Smogorzewski
- Division of Nephrology and Hypertension, Department of Medicine, University of Southern California, Los Angeles, California; and
| | - Mark J Sarnak
- Division of Nephrology, Department of Medicine, Tufts University, Boston, Massachusetts
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17
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WITHDRAWN: Estimated glomerular filtration rate predicts incident stroke among ghanaians with diabetes and hypertension. J Neurol Sci 2018. [DOI: 10.1016/j.jns.2018.09.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Estrella MM, Parekh RS. The Expanding Role of APOL1 Risk in Chronic Kidney Disease and Cardiovascular Disease. Semin Nephrol 2018; 37:520-529. [PMID: 29110759 DOI: 10.1016/j.semnephrol.2017.07.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Variants of the APOL1 gene, found primarily in individuals of African descent, are associated with various forms of kidney disease and kidney disease progression. Recent studies evaluating the association of APOL1 with cardiovascular disease have yielded conflicting results, and the potential role in cardiovascular disease remains unclear. In this review, we summarize the observational studies linking the APOL1 risk variants with chronic kidney and cardiovascular disease among persons of African descent.
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Affiliation(s)
- Michelle M Estrella
- Kidney Health Research Collaborative, Department of Medicine, University of California San Francisco, San Francisco, CA; Department of Medicine, San Francisco VA Medical Center, San Francisco, CA
| | - Rulan S Parekh
- Division of Nephrology, Departments of Pediatrics and Medicine, The Hospital for Sick Children, SickKids Research Institute, University Health Network, University of Toronto, Toronto, Ontario, Canada.
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19
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[Hypertension in black patients]. JOURNAL DE MÉDECINE VASCULAIRE 2018; 43:213-217. [PMID: 29754732 DOI: 10.1016/j.jdmv.2018.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Accepted: 02/24/2018] [Indexed: 11/22/2022]
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20
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Anand S, Abdalla S, Gathecha G, Oladapo OO, Joseph K, Montez-Rath ME, Aslan M, Barry M, Chertow GM, Rotimi C, Friedman DJ. Association of Apolipoprotein L-1 polymorphisms with blood pressure in three multi-ethnic African studies. JOURNAL OF GLOBAL HEALTH REPORTS 2018. [DOI: 10.29392/joghr.2.e2018005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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Krummel T, Keller N, Prinz É, Hannedouche T. [What is the goal blood pressure in non-diabetic chronic kidney disease?]. Nephrol Ther 2018; 14:446-453. [PMID: 29503160 DOI: 10.1016/j.nephro.2018.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Revised: 01/09/2018] [Accepted: 01/14/2018] [Indexed: 10/17/2022]
Abstract
High blood pressure during renal disease is highly prevalent and an important risk factor for cardiovascular disease and renal progression. Its optimal management is therefore necessary to improve the prognosis of patients. Several trials concerning the blood pressure target in patients with chronic non-diabetic kidney disease have been published in recent years, we will detail them in this article in order to determine which blood pressure target provides the best benefit in terms of progression of renal diseases and cardiovascular prevention.
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Affiliation(s)
- Thierry Krummel
- Service de néphrologie, hôpitaux universitaires de Strasbourg, 1, place de l'Hôpital, 67091 Strasbourg cedex, France.
| | - Nicolas Keller
- Service de néphrologie, hôpitaux universitaires de Strasbourg, 1, place de l'Hôpital, 67091 Strasbourg cedex, France
| | - Éric Prinz
- Service de néphrologie, hôpitaux universitaires de Strasbourg, 1, place de l'Hôpital, 67091 Strasbourg cedex, France
| | - Thierry Hannedouche
- Service de néphrologie, hôpitaux universitaires de Strasbourg, 1, place de l'Hôpital, 67091 Strasbourg cedex, France
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22
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Ku E, Kopple JD, Johansen KL, McCulloch CE, Go AS, Xie D, Lin F, Hamm LL, He J, Kusek JW, Navaneethan SD, Ricardo AC, Rincon-Choles H, Smogorzewski M, Hsu CY. Longitudinal Weight Change During CKD Progression and Its Association With Subsequent Mortality. Am J Kidney Dis 2017; 71:657-665. [PMID: 29217305 DOI: 10.1053/j.ajkd.2017.09.015] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Accepted: 09/12/2017] [Indexed: 01/13/2023]
Abstract
BACKGROUND Few studies have investigated the changes in weight that may occur over time among adults with the progression of chronic kidney disease (CKD). Whether such weight changes are independently associated with death after the onset of end-stage renal disease has also not been rigorously examined. STUDY DESIGN Prospective cohort study. SETTING & PARTICIPANTS We studied 3,933 participants of the Chronic Renal Insufficiency Cohort (CRIC) Study, a longitudinal cohort of patients with CKD. We also performed similar analyses among 1,067 participants of the African American Study of Kidney Disease and Hypertension (AASK). PREDICTORS Estimated glomerular filtration rate (eGFR) and weight change during CKD. OUTCOME Weight and all-cause mortality after dialysis therapy initiation. RESULTS During a median follow-up of 5.7 years in CRIC, weight change was not linear. Weight was stable until cystatin C-based eGFR (eGFRcys) decreased to <35mL/min/1.73m2; thereafter, weight declined at a mean rate of 1.45 kg (95% CI, 1.19-1.70) for every 10 mL/min/1.73m2 decline in eGFRcys. Among the 770 CRIC participants who began hemodialysis or peritoneal dialysis therapy during follow-up, a >5% annualized weight loss after eGFR decreased to <35mL/min/1.73m2 was associated with a 54% higher risk for death after dialysis therapy initiation (95% CI, 1.17-2.03) compared with those with more stable weight (annualized weight changes within 5% of baseline) in adjusted analysis. Similar findings were observed in the AASK. LIMITATIONS Inclusion of research participants only; inability to distinguish intentional versus unintentional weight loss. CONCLUSIONS Significant weight loss began relatively early during the course of CKD and was associated with a substantially higher risk for death after dialysis therapy initiation. Further studies are needed to determine whether interventions to optimize weight and nutritional status before the initiation of dialysis therapy will improve outcomes after end-stage renal disease.
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Affiliation(s)
- Elaine Ku
- Division of Nephrology, Department of Medicine, University of California, San Francisco, San Francisco, CA; Division of Pediatric Nephrology, Department of Pediatrics, University of California, San Francisco, San Francisco, CA.
| | - Joel D Kopple
- Los Angeles Biomedical Research Institute, Harbor-UCLA Medical Center, and University of California, Los Angeles Schools of Medicine and Public Health, Los Angeles, CA
| | - Kirsten L Johansen
- Division of Nephrology, Department of Medicine, University of California, San Francisco, San Francisco, CA; Nephrology Section, San Francisco Veterans Affairs Medical Center, San Francisco, CA
| | - Charles E McCulloch
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA
| | - Alan S Go
- Division of Nephrology, Department of Medicine, University of California, San Francisco, San Francisco, CA; Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA; Division of Research, Kaiser Permanente Northern California, Oakland, CA
| | - Dawei Xie
- Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Feng Lin
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA
| | - L Lee Hamm
- Department of Medicine, Tulane University School of Medicine, New Orleans, LA
| | - Jiang He
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA
| | - John W Kusek
- National Institute of Diabetes, Digestive, and Kidney Diseases, National Institutes of Health, Bethesda, MD
| | | | - Ana C Ricardo
- Division of Nephrology, Department of Medicine, University of Illinois, Chicago, IL
| | - Hernan Rincon-Choles
- Glickman Urological and Kidney Institute, Department of Nephrology, Cleveland Clinic Foundation, Cleveland, OH
| | | | - Chi-Yuan Hsu
- Division of Nephrology, Department of Medicine, University of California, San Francisco, San Francisco, CA
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McLean NO, Robinson TW, Freedman BI. APOL1 Gene Kidney Risk Variants and Cardiovascular Disease: Getting to the Heart of the Matter. Am J Kidney Dis 2017; 70:281-289. [PMID: 28143671 PMCID: PMC5526726 DOI: 10.1053/j.ajkd.2016.11.020] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Accepted: 11/01/2016] [Indexed: 12/12/2022]
Abstract
Apolipoprotein L1 gene (APOL1) renal risk variants exhibit strong genetic associations with a spectrum of nondiabetic kidney diseases in individuals with recent African ancestry. Relationships between APOL1 kidney risk variants and cardiovascular disease (CVD) susceptibility and CVD-related death remain controversial. Some studies detected an increased risk for CVD, whereas others support protection from death and subclinical CVD and cerebrovascular disease. Because treatments for nondiabetic kidney disease may target this gene and its protein products, it remains critical to clarify the potential extrarenal effects of APOL1 kidney risk variants. This review addresses the current literature on APOL1 associations with CVD, cerebrovascular disease, and death. Potential causes of disparate results between studies are discussed.
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Affiliation(s)
- Nicholas O McLean
- Section on Nephrology, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC
| | - Todd W Robinson
- Section on Nephrology, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC
| | - Barry I Freedman
- Section on Nephrology, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC.
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24
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Diversity and inclusion in genomic research: why the uneven progress? J Community Genet 2017; 8:255-266. [PMID: 28770442 PMCID: PMC5614884 DOI: 10.1007/s12687-017-0316-6] [Citation(s) in RCA: 164] [Impact Index Per Article: 23.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Accepted: 06/29/2017] [Indexed: 12/15/2022] Open
Abstract
Conducting genomic research in diverse populations has led to numerous advances in our understanding of human history, biology, and health disparities, in addition to discoveries of vital clinical significance. Conducting genomic research in diverse populations is also important in ensuring that the genomic revolution does not exacerbate health disparities by facilitating discoveries that will disproportionately benefit well-represented populations. Despite the general agreement on the need for genomic research in diverse populations in terms of equity and scientific progress, genomic research remains largely focused on populations of European descent. In this article, we describe the rationale for conducting genomic research in diverse populations by reviewing examples of advances facilitated by their inclusion. We also explore some of the factors that perpetuate the disproportionate attention on well-represented populations. Finally, we discuss ongoing efforts to ameliorate this continuing bias. Collaborative and intensive efforts at all levels of research, from the funding of studies to the publication of their findings, will be necessary to ensure that genomic research does not conserve historical inequalities or curtail the contribution that genomics could make to the health of all humanity.
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25
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Freedman BI, Rocco MV, Bates JT, Chonchol M, Hawfield AT, Lash JP, Papademetriou V, Sedor JR, Servilla K, Kimmel PL, Wall BM, Pajewski NM. APOL1 renal-risk variants do not associate with incident cardiovascular disease or mortality in the Systolic Blood Pressure Intervention Trial. Kidney Int Rep 2017; 2:713-720. [PMID: 28758155 PMCID: PMC5527675 DOI: 10.1016/j.ekir.2017.03.008] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Introduction Relationships between apolipoprotein L1 gene (APOL1) renal-risk variants (RRVs) and cardiovascular disease (CVD) remain controversial. To clarify associations between APOL1 and CVD, a total of 2568 African American Systolic Blood Pressure Intervention Trial (SPRINT) participants were assessed for the incidence of CVD events (primary composite including nonfatal myocardial infarction, acute coronary syndrome not resulting in myocardial infarction, nonfatal stroke, nonfatal acute decompensated heart failure, and CVD death), renal outcomes, and all-cause mortality. Methods Cox proportional hazards regression models were used, adjusting for age, sex, African ancestry proportion, and treatment group (systolic blood pressure target of <120 mm Hg vs. <140 mm Hg). Results Of the participants, 14% had 2 APOL1 RRVs; these individuals also had lower baseline estimated GFR and higher levels of albuminuria and BMI. After a median follow-up of 39 months, no significant association was observed between APOL1 RRVs and the primary composite CVD outcome, any of its components, or all-cause mortality (recessive or additive genetic models). APOL1 demonstrated a trend toward association with sustained 30% reduction in estimated GFR to <60 ml/min/1.73 m2 in those with normal kidney function at baseline (hazard ratio 1.64; 95% confidence interval = 0.85−2.93; P = 0.114, recessive model). Discussion APOL1 RRVs were not associated with incident CVD in high-risk hypertensive, nondiabetic African American participants in SPRINT.
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Affiliation(s)
- Barry I Freedman
- Department of Internal Medicine, Section on Nephrology; Wake Forest School of Medicine, Winston-Salem, NC
| | - Michael V Rocco
- Department of Internal Medicine, Section on Nephrology; Wake Forest School of Medicine, Winston-Salem, NC
| | - Jeffrey T Bates
- Michael E. DeBakey Veterans Administration Medical Center and Baylor College of Medicine, Houston, TX
| | - Michel Chonchol
- Department of Medicine, Division of Renal Diseases and Hypertension; University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Amret T Hawfield
- Department of Internal Medicine, Section on Nephrology; Wake Forest School of Medicine, Winston-Salem, NC
| | - James P Lash
- Department of Medicine, Division of Nephrology; University of Illinois, Chicago, IL
| | - Vasilios Papademetriou
- Center for Hypertension, Kidney & Vascular Research; Georgetown University Medical Center, Washington, DC
| | - John R Sedor
- Department of Medicine; MetroHealth Medical Center and Department of Physiology and Biophysics; Case Western Reserve University, Cleveland, OH
| | - Karen Servilla
- Internal Medicine, Renal Section; New Mexico Veterans Administration Health Care System, Albuquerque, NM
| | - Paul L Kimmel
- National Institute of Diabetes and Digestive and Kidney Diseases; Bethesda, MD
| | - Barry M Wall
- Department of Nephrology; University of Tennessee Health Science Center and Veterans Affairs Medical Center, Memphis, TN
| | - Nicholas M Pajewski
- Department of Biostatistical Sciences, Division of Public Health Sciences; Wake Forest School of Medicine, Winston-Salem, NC
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26
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Robinson TW, Freedman BI. APOL1 genotype, blood pressure, and survival in African Americans with nondiabetic nephropathy. Kidney Int 2017; 91:276-278. [PMID: 28087008 DOI: 10.1016/j.kint.2016.10.027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Accepted: 10/11/2016] [Indexed: 11/20/2022]
Abstract
Several landmark trials have assessed the effects of aggressive hypertension control on the progression of nondiabetic chronic kidney disease. Results generally have been disappointing. With the realization that lowering blood pressure, including with renin-angiotensin system blockade, failed to reliably prevent end-stage kidney disease, studies now are analyzing longer-term effects of hypertension control on survival in chronic kidney disease. This commentary reviews the current findings and extends the discussion to apolipoprotein L1 gene by blood pressure (or gene by environment) interactions.
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Affiliation(s)
- Todd W Robinson
- Section on Nephrology, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Barry I Freedman
- Section on Nephrology, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA.
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