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Adedinsewo DA, Porter IE, White RO, Hickson LJ. Racial and Ethnic Disparities in Cardiovascular Disease Risk Among Patients with Chronic Kidney Disease. Curr Cardiovasc Risk Rep 2022. [DOI: 10.1007/s12170-022-00701-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Garg N, Lentine KL, Inker LA, Garg AX, Rodrigue JR, Segev DL, Mandelbrot DA. The kidney evaluation of living kidney donor candidates: US practices in 2017. Am J Transplant 2020; 20:3379-3389. [PMID: 32342620 DOI: 10.1111/ajt.15951] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 04/17/2020] [Accepted: 04/20/2020] [Indexed: 01/25/2023]
Abstract
We surveyed US transplant programs to assess practices used to assess kidney health in living kidney donor candidates in 2017; the response rate was 31%. In this report, we focus on the kidney; a companion piece focuses on the metabolic and cardiovascular aspects of candidate evaluation. Compared to 2005, programs have become more stringent in accepting younger candidates and less stringent in accepting older candidates. The 24-hour creatinine clearance remains the mainstay for kidney function assessment, with 74% continuing to use a value below 80 mL/min/1.73 m2 for exclusion and 22% using age-based criteria. ApoL1 genotyping is obtained routinely or selectively by 45%, half of which use the high-risk genotype as an absolute exclusion criterion. For history of symptomatic stones, 49% accept if there is no current radiographic evidence of stones and urine profile is low risk, 80%-95% consider candidates with unilateral asymptomatic stones, but only 33%-48% consider if stones are bilateral. In addition, 14% use the risk assessment tool developed by Grams et al routinely for decision-making, and 42% use it sometimes. Also, 57% reported not having yet determined a risk threshold for acceptable postdonation risk above which candidates are excluded. Contemporary practice variation underscores the need for better evidence to guide the donor selection process.
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Affiliation(s)
- Neetika Garg
- Division of Nephrology, Department of Medicine, University of Wisconsin, School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Krista L Lentine
- Center for Abdominal Transplantation, Saint Louis University School of Medicine, St. Louis, Wisconsin, USA
| | - Lesley A Inker
- Division of Nephrology, Department of Medicine, Tufts Medical Center, Boston, Massachusetts, USA
| | - Amit X Garg
- Division of Nephrology, Department of Medicine, Western University, London, Ontario, Canada
| | - James R Rodrigue
- Beth Israel Deaconess Medical Center, Transplant Institute, Boston, Massachusetts, USA.,Departments of Surgery and Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
| | - Dorry L Segev
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Didier A Mandelbrot
- Division of Nephrology, Department of Medicine, University of Wisconsin, School of Medicine and Public Health, Madison, Wisconsin, USA
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Chen TK, Fitzpatrick J, Winkler CA, Binns-Roemer EA, Corona-Villalobos CP, Jaar BG, Sozio SM, Parekh RS, Estrella MM. APOL1 Risk Variants and Subclinical Cardiovascular Disease in Incident Hemodialysis Patients. Kidney Int Rep 2020; 6:333-341. [PMID: 33615058 PMCID: PMC7879092 DOI: 10.1016/j.ekir.2020.11.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 10/23/2020] [Accepted: 11/10/2020] [Indexed: 01/13/2023] Open
Abstract
Introduction To better understand the impact of APOL1 risk variants in end-stage renal disease (ESRD) we evaluated associations of APOL1 risk variants with subclinical cardiovascular disease (CVD) and mortality among African Americans initiating hemodialysis and enrolled in the Predictors of Arrhythmic and Cardiovascular Risk in ESRD cohort study. Methods We modeled associations of APOL1 risk status (high = 2; low = 0/1 risk alleles) with baseline subclinical CVD (left ventricular [LV] hypertrophy; LV mass; ejection fraction; coronary artery calcification [CAC]; pulse wave velocity [PWV]) using logistic and linear regression and all-cause or cardiovascular mortality using Cox models, adjusting for age, sex, and ancestry. In sensitivity analyses, we further adjusted for systolic blood pressure and Charlson Comorbidity Index. Results Of 267 African American participants successfully genotyped for APOL1, 27% were high-risk carriers, 41% were women, and mean age was 53 years. At baseline, APOL1 high- versus low-risk status was independently associated with 50% and 53% lower odds of LV hypertrophy and CAC, respectively, and 10.7% lower LV mass. These associations were robust to further adjustment for comorbidities but not systolic blood pressure. APOL1 risk status was not associated with all-cause or cardiovascular mortality (mean follow-up 2.5 years). Conclusion Among African American patients with incident hemodialysis, APOL1 high-risk status was associated with better subclinical measures of CVD but not mortality.
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Affiliation(s)
- Teresa K. Chen
- Division of Nephrology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
- Correspondence: Teresa K. Chen, Division of Nephrology, Johns Hopkins University School of Medicine, 1830 East Monument Street, Suite 416, Baltimore, Maryland 21287, USA.
| | - Jessica Fitzpatrick
- Departments of Pediatrics and Medicine, Hospital for Sick Children, University Health Network and University of Toronto, Toronto, Ontario, Canada
| | - Cheryl A. Winkler
- Basic Research Program, Frederick National Laboratory, Frederick, Maryland, USA
| | | | - Celia P. Corona-Villalobos
- Division of Nephrology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Bernard G. Jaar
- Division of Nephrology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Nephrology Center of Maryland, Baltimore, Maryland, USA
| | - Stephen M. Sozio
- Division of Nephrology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Rulan S. Parekh
- Departments of Pediatrics and Medicine, Hospital for Sick Children, University Health Network and University of Toronto, Toronto, Ontario, Canada
| | - Michelle M. Estrella
- Kidney Health Research Collaborative, Department of Medicine, University of California, San Francisco, San Francisco, California, USA
- San Francisco VA Health Care System, San Francisco, California, USA
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Datta S, Kataria R, Zhang JY, Moore S, Petitpas K, Mohamed A, Zahler N, Pollak MR, Olabisi OA. Kidney Disease-Associated APOL1 Variants Have Dose-Dependent, Dominant Toxic Gain-of-Function. J Am Soc Nephrol 2020; 31:2083-2096. [PMID: 32675303 PMCID: PMC7461666 DOI: 10.1681/asn.2020010079] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Accepted: 05/12/2020] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Two coding renal risk variants (RRVs) of the APOL1 gene (G1 and G2) are associated with large increases in CKD rates among populations of recent African descent, but the underlying molecular mechanisms are unknown. Mammalian cell culture models are widely used to study cytotoxicity of RRVs, but results have been contradictory. It remains unclear whether cytotoxicity is RRV-dependent or driven solely by variant-independent overexpression. It is also unknown whether expression of the reference APOL1 allele, the wild-type G0, could prevent cytotoxicity of RRVs. METHODS We generated tetracycline-inducible APOL1 expression in human embryonic kidney HEK293 cells and examined the effects of increased expression of APOL1 (G0, G1, G2, G0G0, G0G1, or G0G2) on known cytotoxicity phenotypes, including reduced viability, increased swelling, potassium loss, aberrant protein phosphorylation, and dysregulated energy metabolism. Furthermore, whole-genome transcriptome analysis examined deregulated canonical pathways. RESULTS At moderate expression, RRVs but not G0 caused cytotoxicity in a dose-dependent manner that coexpression of G0 did not reduce. RRVs also have dominant effects on canonical pathways relevant for the cellular stress response. CONCLUSIONS In HEK293 cells, RRVs exhibit a dominant toxic gain-of-function phenotype that worsens with increasing expression. These observations suggest that high steady-state levels of RRVs may underlie cellular injury in APOL1 nephropathy, and that interventions that reduce RRV expression in kidney compartments may mitigate APOL1 nephropathy.
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Affiliation(s)
- Somenath Datta
- Division of Nephrology and Duke Molecular Physiology Institute, Duke University, Durham, North Carolina
- Division of Nephrology, Massachusetts General Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Rama Kataria
- Division of Nephrology, Massachusetts General Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Jia-Yue Zhang
- Harvard Medical School, Boston, Massachusetts
- Division of Nephrology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Savannah Moore
- Division of Nephrology, Massachusetts General Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Kaitlyn Petitpas
- Division of Nephrology, Massachusetts General Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Adam Mohamed
- Division of Nephrology, Massachusetts General Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | | | - Martin R Pollak
- Harvard Medical School, Boston, Massachusetts
- Division of Nephrology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Opeyemi A Olabisi
- Division of Nephrology and Duke Molecular Physiology Institute, Duke University, Durham, North Carolina
- Division of Nephrology, Massachusetts General Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
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Modi ZJ, Lu Y, Ji N, Kapke A, Selewski DT, Dietrich X, Abbott K, Nallamothu BK, Schaubel DE, Saran R, Gipson DS. Risk of Cardiovascular Disease and Mortality in Young Adults With End-stage Renal Disease: An Analysis of the US Renal Data System. JAMA Cardiol 2020; 4:353-362. [PMID: 30892557 DOI: 10.1001/jamacardio.2019.0375] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Importance Cardiovascular disease (CVD) is a leading cause of death among patients with end-stage renal disease (ESRD). Young adult (ages 22-29 years) have risks for ESRD-associated CVD that may vary from other ages. Objective To test the hypothesis that young adult-onset ESRD is associated with higher cardiovascular (CV) hospitalizations and mortality with different characteristics than childhood-onset disease. Design, Setting, and Participants This population-based cohort study used the US Renal Data System to categorize patients who initiated ESRD care between 2003 and 2013 by age at ESRD onset (1-11, 12-21, and 22-29 years). Cardiovascular hospitalizations were identified via International Classification of Diseases, Ninth Revision discharge codes and CV mortality from the Centers for Medicare & Medicaid ESRD Death Notification Form. Patients were censored at death from non-CVD events, loss to follow-up, recovery, or survival to December 31, 2014. Adjusted proportional hazard models (95% CI) were fit to determine risk of CV hospitalization and mortality by age group. Data analysis occurred from May 2016 and December 2017. Exposures Onset of ESRD. Main Outcomes and Measures Cardiovascular mortality and hospitalization. Results A total of 33 156 patients aged 1 to 29 years were included in the study population. Young adults (aged 22-29 years) had a 1-year CV hospitalization rate of 138 (95% CI, 121-159) per 1000 patient-years. Young adults had a higher risk for CV hospitalization than children (aged 1-11 years; hazard ratio [HR], 0.41 [95% CI, 0.26-0.64]) and adolescents (aged 12-21 years; HR, 0.86 [95% CI, 0.77-0.97]). Of 4038 deaths in young adults, 1577 (39.1%) were owing to CVD. Five-year cumulative incidence of mortality in this group (7.3%) was higher than in younger patients (adolescents, 4.0%; children, 1.7%). Adjusted HRs for CV mortality were higher for young adults with all causes of ESRD than children (cystic, hereditary, and congenital conditions: HR, 0.22 [95% CI, 0.11-0.46]; P < .001; glomerulonephritis: HR, 0.21 [95% CI, 0.10-0.44]; P < .001; other conditions: HR, 0.33 [95% CI, 0.23-0.49]; P < .001). Adolescents had a lower risk for CV mortality than young adults for all causes of ESRD except glomerulonephritis (cystic, hereditary, and congenital conditions: HR, 0.45 [95% CI, 0.27-0.74]; glomerulonephritis: HR, 0.99 [95% CI, 0.76-1.11]; other: HR, 0.47 [95% CI, 0.40-0.57]). Higher risks for CV hospitalization and mortality were associated with lack of preemptive transplant compared with hemodialysis (hospital: HR, 14.24 [95% CI, 5.92-34.28]; mortality: HR, 13.64 [95% CI, 8.79-21.14]) and peritoneal dialysis [hospital: HR, 8.47 [95% CI, 3.50-20.53]; mortality: HR, 7.86 [95% CI, 4.96-12.45]). Nephrology care before ESRD was associated with lower risk for CV mortality (HR, 0.77 [95% CI, 0.70-0.85]). Conclusions and Relevance Cardiovascular disease accounted for nearly 40% of deaths in young adults with incident ESRD in this cohort. Identified risk factors may inform development of age-appropriate ESRD strategies to improve the CV health of this population.
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Affiliation(s)
- Zubin J Modi
- Division of Pediatric Nephrology, Department of Pediatrics, University of Michigan, Ann Arbor.,Susan B. Meister Child Health Evaluation and Research Center, University of Michigan, Ann Arbor
| | - Yee Lu
- Division of Nephrology, Department of Internal Medicine, University of Michigan, Ann Arbor
| | - Nan Ji
- Arbor Research Collaborative for Health, Ann Arbor, Michigan
| | - Alissa Kapke
- Arbor Research Collaborative for Health, Ann Arbor, Michigan
| | - David T Selewski
- Division of Pediatric Nephrology, Department of Pediatrics, University of Michigan, Ann Arbor
| | - Xue Dietrich
- Arbor Research Collaborative for Health, Ann Arbor, Michigan
| | - Kevin Abbott
- National Institute of Health, National Institute of Diabetes and Digestive and Kidney Diseases, Kidney Urology and Epidemiology, Bethesda, Maryland
| | - Brahmajee K Nallamothu
- Division of Cardiology, Department of Internal Medicine, University of Michigan, Ann Arbor.,Michigan Integrated Center for Health Analytics & Medical Prediction, University of Michigan, Ann Arbor
| | - Douglas E Schaubel
- Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor.,Kidney Epidemiology and Cost Center, School of Public Health, University of Michigan, Ann Arbor
| | - Rajiv Saran
- Division of Nephrology, Department of Internal Medicine, University of Michigan, Ann Arbor.,Kidney Epidemiology and Cost Center, School of Public Health, University of Michigan, Ann Arbor.,Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor
| | - Debbie S Gipson
- Division of Pediatric Nephrology, Department of Pediatrics, University of Michigan, Ann Arbor
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Gutiérrez OM, Irvin MR, Zakai NA, Naik RP, Chaudhary NS, Estrella MM, Limou S, Judd SE, Cushman M, Kopp JB, Winkler CA. APOL1 Nephropathy Risk Alleles and Mortality in African American Adults: A Cohort Study. Am J Kidney Dis 2020; 75:54-60. [PMID: 31563468 PMCID: PMC7008402 DOI: 10.1053/j.ajkd.2019.05.027] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Accepted: 05/22/2019] [Indexed: 01/13/2023]
Abstract
RATIONALE & OBJECTIVE APOL1 nephropathy risk alleles are associated with the development of chronic kidney disease (CKD) in African Americans. Although CKD is an established risk factor for mortality, associations of APOL1 risk alleles with mortality are uncertain. STUDY DESIGN Prospective cohort. SETTINGS & PARTICIPANTS 10,380 African American and 17,485 white American participants in the Reasons for Geographic and Racial Differences in Stroke (REGARDS) Study. EXPOSURES APOL1 nephropathy risk alleles. OUTCOMES All-cause and cause-specific mortality. ANALYTICAL APPROACH Cox proportional hazards models were used to examine the association of APOL1 high-risk genotypes (2 risk alleles) versus APOL1 low-risk genotypes (0/1 risk allele) with all-cause and cause-specific mortality in African Americans and examine the risk for all-cause mortality in African Americans with high-risk genotypes versus African Americans with low-risk genotypes and white Americans. RESULTS APOL1 high-risk participants were younger and had a higher prevalence of albuminuria than low-risk participants. There was no statistically significant association of APOL1 high- versus low-risk genotypes with all-cause mortality in models adjusted for sociodemographic variables, comorbid conditions, and kidney function (HR, 0.88; 95% CI, 0.77-1.01). After further adjustment for genetic ancestry in a subset with available data, a statistically significant association emerged (HR, 0.81; 95% CI, 0.69-0.96). Associations differed by CKD status (Pinteraction=0.04), with African Americans with high-risk genotypes having lower risk for mortality than those with low-risk genotypes in fully adjusted models (HR, 0.78; 95% CI, 0.62-0.99) among those with CKD, but not those without CKD (HR, 0.84; 95% CI, 0.66-1.05). Compared with white Americans, African Americans with high-risk genotypes had a similar rate of mortality, whereas African Americans with low-risk genotypes had a higher rate of mortality (HR, 1.07; 95% CI, 1.00-1.14) in fully adjusted models. LIMITATIONS Lack of follow-up measures of kidney function. CONCLUSIONS African Americans with high-risk APOL1 genotypes had lower mortality than those with low-risk genotypes in multivariable-adjusted models including genetic ancestry.
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Affiliation(s)
- Orlando M Gutiérrez
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL; Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL
| | - Marguerite R Irvin
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL
| | - Neil A Zakai
- Departments of Medicine and Pathology, Robert Larner College of Medicine, University of Vermont, Burlington, VT
| | - Rakhi P Naik
- Department of Medicine, Division of Hematology, Johns Hopkins Medicine, Baltimore, MD
| | - Ninad S Chaudhary
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL
| | - Michelle M Estrella
- Kidney Health Research Collaborative, Department of Medicine, University of California, San Francisco, CA; San Francisco VA Medical Center, San Francisco, CA
| | | | - Suzanne E Judd
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham, AL
| | - Mary Cushman
- Departments of Medicine and Pathology, Robert Larner College of Medicine, University of Vermont, Burlington, VT; Department of Laboratory Medicine, Robert Larner College of Medicine, University of Vermont, Burlington, VT
| | - Jeffrey B Kopp
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD
| | - Cheryl A Winkler
- Basic Research Program, Frederick National Laboratory for Cancer Research, Frederick, MD.
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Gutiérrez OM, Irvin MR, Chaudhary NS, Cushman M, Zakai NA, David VA, Limou S, Pamir N, Reiner AP, Naik RP, Sale MM, Safford MM, Hyacinth HI, Judd SE, Kopp JB, Winkler CA. APOL1 Nephropathy Risk Variants and Incident Cardiovascular Disease Events in Community-Dwelling Black Adults. Circ Genom Precis Med 2019; 11:e002098. [PMID: 29899045 DOI: 10.1161/circgen.117.002098] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Accepted: 04/04/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND APOL1 renal risk variants are strongly associated with chronic kidney disease in Black adults, but reported associations with cardiovascular disease (CVD) have been conflicting. METHODS We examined associations of APOL1 with incident coronary heart disease (n=323), ischemic stroke (n=331), and the composite CVD outcome (n=500) in 10 605 Black participants of the REGARDS study (Reasons for Geographic and Racial Differences in Stroke). Primary analyses compared individuals with APOL1 high-risk genotypes to APOL1 low-risk genotypes in Cox proportional hazards models adjusted for CVD risk factors and African ancestry. RESULTS APOL1 high-risk participants were younger and more likely to have albuminuria at baseline than APOL1 low-risk participants. The risk of incident stroke, coronary heart disease, or composite CVD end point did not significantly differ by APOL1 genotype status in multivariable models. The association of APOL1 genotype with incident composite CVD differed by diabetes mellitus status (Pinteraction=0.004). In those without diabetes mellitus, APOL1 high-risk genotypes associated with greater risk of incident composite CVD (hazard ratio, 1.67; 95% confidence interval, 1.12-2.47) compared with those with APOL1 low-risk genotypes in multivariable adjusted models. This latter association was driven by ischemic strokes (hazard ratio, 2.32; 95% confidence interval, 1.33-4.07), in particular, those related to small vessel disease (hazard ratio, 5.10; 95% confidence interval, 1.55-16.56). There was no statistically significant association of APOL1 genotypes with incident CVD in subjects with diabetes mellitus. The APOL1 high-risk genotype was associated with higher stroke risk in individuals without but not those with chronic kidney disease in fully adjusted models. CONCLUSIONS APOL1 high-risk status is associated with CVD events in community-dwelling Black adults without diabetes mellitus.
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Affiliation(s)
- Orlando M Gutiérrez
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL (O.M.G.)
| | - Marguerite R Irvin
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL (M.R.I., N.S.C.)
| | - Ninad S Chaudhary
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL (M.R.I., N.S.C.)
| | - Mary Cushman
- Division of Hematology and Oncology, University of Vermont, Burlington, VT (M.C., N.A.Z.)
| | - Neil A Zakai
- Division of Hematology and Oncology, University of Vermont, Burlington, VT (M.C., N.A.Z.)
| | - Victor A David
- Basic Research Laboratory, Center for Cancer Research, National Cancer Institute, Frederick, MD (V.A.D.)
| | - Sophie Limou
- Basic Research Laboratory, National Cancer Institute, National Institutes of Health, Leidos Biomedical Research, Frederick National Laboratory, Frederick, MD (S.L., C.A.W.).,Center for Research in Immunology and Transplantation, University of Nantes, Nantes, France (S.L.)
| | - Nathalie Pamir
- Knight Cardiovascular Institute, Oregon Health and Science University, Portland, OR (N.P.)
| | - Alex P Reiner
- Department of Epidemiology, University of Washington, Seattle, WA (A.P.R.)
| | - Rakhi P Naik
- Department of Medicine, Johns Hopkins School of Medicine, Johns Hopkins University, Baltimore, MD (R.P.N.)
| | - Michele M Sale
- Center for Public Health Genomics, University of Virginia, Charlottesville, VA (M.M. Sale)
| | - Monika M Safford
- Division of General Internal Medicine, Weill Cornell Medicine, New York, NY (M.M. Safford)
| | - Hyacinth I Hyacinth
- Department of Pediatrics, Aflac Cancer and Blood Disorder Center, Children's Healthcare of Atlanta, Emory University, Atlanta, GA (H.I.H.)
| | - Suzanne E Judd
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham, AL (S.E.J.)
| | - Jeffrey B Kopp
- Kidney Diseases Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD (J.B.K.).
| | - Cheryl A Winkler
- Basic Research Laboratory, National Cancer Institute, National Institutes of Health, Leidos Biomedical Research, Frederick National Laboratory, Frederick, MD (S.L., C.A.W.)
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Murea M, Ma L, Freedman BI. APOL1 and Mortality in Patients on Dialysis. Cardiorenal Med 2019; 9:261-264. [PMID: 31185465 DOI: 10.1159/000501303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Accepted: 06/04/2019] [Indexed: 11/19/2022] Open
Affiliation(s)
- Mariana Murea
- Department of Internal Medicine, Section on Nephrology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Lijun Ma
- Department of Internal Medicine, Section on Nephrology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Barry I Freedman
- Department of Internal Medicine, Section on Nephrology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA,
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10
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Lertdumrongluk P, Streja E, Rhee CM, Moradi H, Chang Y, Reddy U, Tantisattamo E, Kalantar-Zadeh K, Kopp JB. Survival Advantage of African American Dialysis Patients with End-Stage Renal Disease Causes Related to APOL1. Cardiorenal Med 2019; 9:212-221. [PMID: 30995638 DOI: 10.1159/000496472] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Accepted: 12/22/2018] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Observational studies show that African American (AA) dialysis patients have longer survival than European Americans. We hypothesized that apolipoprotein L1 (APOL1) genetic variation, associated with nephropathy in AAs, contributes to the survival advantage in AA dialysis patients. METHODS We examined the association between race and mortality among 37,097 adult dialysis patients, including 54% AAs and 46% European Americans from a large dialysis organization (entry period from July 2001 to June 2006, follow-up through June 2007), within each cause of end-stage renal disease (ESRD) category associated with APOL1 renal risk variants using Cox proportional hazard models. RESULTS AA dialysis patients had numerically lower mortality than their European American counterparts for all causes of ESRD. The mortality reduction among AAs compared to European Americans was statistically significant in patients with ESRD attributed to diabetes mellitus, hypertension, and APOL1-enriched glomerulonephritis (GN) (HR [95% CI]: 0.69 [0.66-0.72], 0.73 [0.68-0.79], and 0.89 [0.79-0.99], respectively); these are conditions in which APOL1 variants promote kidney disease. By contrast, the significant survival advantage of AA dialysis patients was not observed in patients with ESRD attributed to other kidney disease (including polycystic kidney disease, interstitial nephritis, and pyelonephritis) and other GN, which are not associated with APOL1 variants. CONCLUSIONS These data suggest the hypothesis that the relative survival advantage of AA dialysis patients may be related to APOL1 variation. Further large population-based genetic studies are required to test this hypothesis.
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Affiliation(s)
- Paungpaga Lertdumrongluk
- Harold Simmons Center for Kidney Disease Research and Epidemiology, Orange, California, USA.,Panyananthaphikkhu Chonprathan Medical Center, Srinakharinwirot University, Nonthaburi, Thailand
| | - Elani Streja
- Harold Simmons Center for Kidney Disease Research and Epidemiology, Orange, California, USA.,University of California Irvine School of Medicine, Orange, California, USA
| | - Connie M Rhee
- Harold Simmons Center for Kidney Disease Research and Epidemiology, Orange, California, USA.,University of California Irvine School of Medicine, Orange, California, USA
| | - Hamid Moradi
- Harold Simmons Center for Kidney Disease Research and Epidemiology, Orange, California, USA
| | - Yongen Chang
- Harold Simmons Center for Kidney Disease Research and Epidemiology, Orange, California, USA
| | - Uttam Reddy
- Harold Simmons Center for Kidney Disease Research and Epidemiology, Orange, California, USA
| | - Ekamol Tantisattamo
- Harold Simmons Center for Kidney Disease Research and Epidemiology, Orange, California, USA
| | - Kamyar Kalantar-Zadeh
- Harold Simmons Center for Kidney Disease Research and Epidemiology, Orange, California, USA.,University of California Irvine School of Medicine, Orange, California, USA
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11
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Abstract
Recent advances in genetics of renal disease have deepened our understanding of progressive kidney disease. Here, we review genetic variants that are of particular importance to progressive glomerular disease that result in end-stage kidney disease (ESKD). Some of the most striking findings relate to APOL1 genetic variants, seen exclusively in individuals of sub-Saharan African descent, that create a predisposition to particular renal disorders, including focal segmental glomerulosclerosis and arterionephrosclerosis. We also review the genetics of cardiovascular disease in ESKD and note that little work has been published on the genetics of other ESKD complications, including anemia, bone disease, and infections. Deeper understanding of the genetics of ESKD and its complications may lead to new therapies that are tailored to an individual patient's genetic profile or are discovered based on genetic approaches that identify novel pathways of renal cell injury and repair.
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Abstract
After more than 6 decades of clinical practice, the transplant community continues to research noninvasive biomarkers of solid organ injury to help improve patient care. In this review, we discuss the clinical usefulness of selective biomarkers and how they are processed at the laboratory. In addition, we organize these biomarkers based on specific aims and introduce innovative markers currently under investigation.
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Affiliation(s)
- John Choi
- Transplantation Research Center, Renal Division, Brigham and Women's Hospital, Harvard Medical School, 221 Longwood Avenue, Boston, MA 02115, USA
| | - Albana Bano
- Transplantation Research Center, Renal Division, Brigham and Women's Hospital, Harvard Medical School, 221 Longwood Avenue, Boston, MA 02115, USA
| | - Jamil Azzi
- Transplantation Research Center, Renal Division, Brigham and Women's Hospital, Harvard Medical School, 221 Longwood Avenue, Boston, MA 02115, USA.
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13
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Siemens TA, Riella MC, Moraes TPD, Riella CV. APOL1 risk variants and kidney disease: what we know so far. ACTA ACUST UNITED AC 2018; 40:388-402. [PMID: 30052698 PMCID: PMC6533999 DOI: 10.1590/2175-8239-jbn-2017-0033] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Accepted: 04/19/2018] [Indexed: 01/08/2023]
Abstract
There are striking differences in chronic kidney disease between Caucasians and African descendants. It was widely accepted that this occurred due to socioeconomic factors, but recent studies show that apolipoprotein L-1 (APOL1) gene variants are strongly associated with focal segmental glomerulosclerosis, HIV-associated nephropathy, hypertensive nephrosclerosis, and lupus nephritis in the African American population. These variants made their way to South America trough intercontinental slave traffic and conferred an evolutionary advantage to the carries by protecting against forms of trypanosomiasis, but at the expense of an increased risk of kidney disease. The effect of the variants does not seem to be related to their serum concentration, but rather to local action on the podocytes. Risk variants are also important in renal transplantation, since grafts from donors with risk variants present worse survival.
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14
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Abstract
Common DNA sequence variants rarely have a high-risk association with a common disease. When such associations do occur, evolutionary forces must be sought, such as in the association of apolipoprotein L1 (APOL1) gene risk variants with nondiabetic kidney diseases in populations of African ancestry. The variants originated in West Africa and provided pathogenic resistance in the heterozygous state that led to high allele frequencies owing to an adaptive evolutionary selective sweep. However, the homozygous state is disadvantageous and is associated with a markedly increased risk of a spectrum of kidney diseases encompassing hypertension-attributed kidney disease, focal segmental glomerulosclerosis, human immunodeficiency virus nephropathy, sickle cell nephropathy, and progressive lupus nephritis. This scientific success story emerged with the help of the tools developed over the past 2 decades in human genome sequencing and population genomic databases. In this introductory article to a timely issue dedicated to illuminating progress in this area, we describe this unique population genetics and evolutionary medicine detective story. We emphasize the paradox of the inheritance mode, the missing heritability, and unresolved associations, including cardiovascular risk and diabetic nephropathy. We also highlight how genetic epidemiology elucidates mechanisms and how the principles of evolution can be used to unravel conserved pathways affected by APOL1 that may lead to novel therapies. The APOL1 gene provides a compelling example of a common variant association with common forms of nondiabetic kidney disease occurring in a continental population isolate with subsequent global admixture. Scientific collaboration using multiple experimental model systems and approaches should further clarify pathomechanisms further, leading to novel therapies.
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Affiliation(s)
| | - Walter G Wasser
- Department of Nephrology, Rambam Health Care Campus, Haifa, Israel; Department of Nephrology, Mayanei HaYeshua Medical Center, Bnei Brak, Israel
| | - Karl Skorecki
- Department of Nephrology, Rambam Health Care Campus, Haifa, Israel; Department of Genetics and Developmental Biology, Rappaport Faculty of Medicine and Research Institute Technion-Israel Institute of Technology, Rambam Health Care Campus, Haifa, Israel.
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15
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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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16
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Gutiérrez OM, Limou S, Lin F, Peralta CA, Kramer HJ, Carr JJ, Bibbins-Domingo K, Winkler CA, Lewis CE, Kopp JB. APOL1 nephropathy risk variants do not associate with subclinical atherosclerosis or left ventricular mass in middle-aged black adults. Kidney Int 2018; 93:727-732. [PMID: 29042080 PMCID: PMC5826778 DOI: 10.1016/j.kint.2017.08.019] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Revised: 08/21/2017] [Accepted: 08/24/2017] [Indexed: 12/29/2022]
Abstract
Prior studies reported associations of APOL1 nephropathy risk variants with subclinical atherosclerosis. However, these findings were limited to older individuals with high comorbidities. To evaluate this in younger individuals, we calculated associations of APOL1 risk variants (high risk [2 risk variants] vs. low risk [0-1 risk variant]) with prevalent, incident, or progressive coronary artery calcification, a carotid intima media thickness over the 90th percentile, and left ventricular hypertrophy in 1315 black participants of the Coronary Artery Risk Development in Young Adults (CARDIA) study. The mean age of this cohort was 44.6 years and their mean estimated glomerular filtration rate was 102.5 ml/min/1.73m2. High-risk participants were found to be younger and have a higher prevalence of albuminuria than low-risk participants. In Poisson regression models adjusted for comorbidities and kidney function, the risk of prevalent coronary artery calcification (relative risk [95% confidence interval] 1.12 [0.72,1.71]), the incident coronary artery calcification (1.50 [0.87,2.59]), and the progression of coronary artery calcification (1.40 [0.88,2.23]) did not significantly differ in high vs. low-risk participants. Furthermore, the risk of carotid intima media thickness over the 90th percentile (1.28 [0.78,2.10]) and left ventricular hypertrophy (1.02[0.73,1.43]) did not significantly differ in high vs. low-risk participants in fully-adjusted models. Thus, APOL1 risk variants did not associate with subclinical markers of atherosclerosis or left ventricular hypertrophy in middle-aged black adults with preserved kidney function.
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Affiliation(s)
| | - Sophie Limou
- Institute for Transplantation in Urology and Nephrology and Ecole Centrale de Nantes, Nantes, France
| | - Feng Lin
- University of California, San Francisco, San Francisco, California, USA
| | - Carmen A Peralta
- University of California, San Francisco, San Francisco, California, USA
| | | | | | | | - Cheryl A Winkler
- Basic Research Laboratory, Center for Cancer Research, National Cancer Institute, Leidos Biomedical Inc., Frederick National Laboratory, Frederick, Maryland, USA
| | - Cora E Lewis
- University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Jeffrey B Kopp
- Kidney Diseases Branch, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, Maryland, USA
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17
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Doshi MD, Ortigosa-Goggins M, Garg AX, Li L, Poggio ED, Winkler CA, Kopp JB. APOL1 Genotype and Renal Function of Black Living Donors. J Am Soc Nephrol 2018; 29:1309-1316. [PMID: 29339549 DOI: 10.1681/asn.2017060658] [Citation(s) in RCA: 96] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Accepted: 12/17/2017] [Indexed: 12/29/2022] Open
Abstract
Black living kidney donors are at higher risk of developing kidney disease than white donors. We examined the effect of the APOL1 high-risk genotype on postdonation renal function in black living kidney donors and evaluated whether this genotype alters the association between donation and donor outcome. We grouped 136 black living kidney donors as APOL1 high-risk (two risk alleles; n=19; 14%) or low-risk (one or zero risk alleles; n=117; 86%) genotype. Predonation characteristics were similar between groups, except for lower mean±SD baseline eGFR (CKD-EPI equation) in donors with the APOL1 high-risk genotype (98±17 versus 108±20 ml/min per 1.73 m2; P=0.04). At a median of 12 years after donation, donors with the APOL1 high-risk genotype had lower eGFR (57±18 versus 67±15 ml/min per 1.73 m2; P=0.02) and faster decline in eGFR after adjusting for predonation eGFR (1.19; 95% confidence interval, 0 to 2.3 versus 0.4; 95% confidence interval, 0.1 to 0.7 ml/min per 1.73 m2 per year, P=0.02). Two donors developed ESRD; both carried the APOL1 high-risk genotype. In a subgroup of 115 donors matched to 115 nondonors by APOL1 genotype, we did not find a difference between groups in the rate of eGFR decline (P=0.39) or any statistical interaction by APOL1 status (P=0.92). In conclusion, APOL1 high-risk genotype in black living kidney donors associated with greater decline in postdonation kidney function. Trajectory of renal function was similar between donors and nondonors. The association between APOL1 high-risk genotype and poor renal outcomes in kidney donors requires validation in a larger study.
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Affiliation(s)
- Mona D Doshi
- Division of Nephrology, University of Michigan, Ann Arbor, Michigan;
| | | | - Amit X Garg
- Division of Nephrology, Western University, London, Ontario, Canada
| | - Lihua Li
- Division of Nephrology, Western University, London, Ontario, Canada
| | - Emilio D Poggio
- Department of Nephrology and Hypertension, Cleveland Clinic, Cleveland, Ohio; and
| | - Cheryl A Winkler
- Basic Research Laboratory, National Cancer Institute, Leidos Biomedical Research, Frederick Laboratory for Cancer Research, Frederick, Maryland and
| | - Jeffrey B Kopp
- Kidney Disease Branch of National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland
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18
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Chen TK, Estrella MM. APOL1 risk variants and death among African American hemodialysis patients: survival of the fittest? Kidney Int 2017; 90:249-252. [PMID: 27418089 DOI: 10.1016/j.kint.2016.03.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Accepted: 03/24/2016] [Indexed: 11/16/2022]
Abstract
Recent studies have focused on associations of the APOL1 risk variants with outcomes beyond kidney disease, including cardiovascular disease and mortality. Ma and colleagues now expand on this growing but contradicting body of work. Their analysis of a prevalent cohort of African American hemodialysis patients shows that the risk variants are associated with a survival benefit among nondiabetics. Whether this simply reflects a healthier status at hemodialysis initiation among those carrying 2 risk variants or whether these variants truly confer a survival advantage is unclear.
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Affiliation(s)
- Teresa K Chen
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Michelle M Estrella
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
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19
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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20
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Chen TK, Appel LJ, Grams ME, Tin A, Choi MJ, Lipkowitz MS, Winkler CA, Estrella MM. APOL1 Risk Variants and Cardiovascular Disease: Results From the AASK (African American Study of Kidney Disease and Hypertension). Arterioscler Thromb Vasc Biol 2017; 37:1765-1769. [PMID: 28572159 DOI: 10.1161/atvbaha.117.309384] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Accepted: 05/22/2017] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Among African Americans, the apolipoprotein L1 (APOL1) risk variants have been associated with various types of kidney disease and chronic kidney disease progression. We aimed to determine whether these same risk variants also confer an increased risk for cardiovascular disease. APPROACH AND RESULTS In a cohort of African Americans with hypertension-attributed chronic kidney disease followed for up to 12 years, we used Cox proportional hazards models to estimate the relative hazard of a composite cardiovascular disease outcome (cardiovascular death or hospitalization for myocardial infarction, cardiac revascularization procedure, heart failure, or stroke) for the APOL1 high- (2 risk variants) versus low-risk (0-1 risk variant) genotypes. We adjusted for age, sex, ancestry, smoking, heart disease history, body mass index, cholesterol, randomized treatment groups, and baseline and longitudinal estimated glomerular filtration rate, systolic blood pressure, and proteinuria. Among 693 participants with APOL1 genotyping available (23% high risk), the high-risk group had lower mean estimated glomerular filtration rate (44.7 versus 50.1 mL/min per 1.73 m2) and greater proteinuria (median 0.19 versus 0.06) compared with the low-risk group at baseline. There was no significant association between APOL1 genotypes and the composite cardiovascular disease outcome in both unadjusted (hazard ratio=1.23; 95% confidence interval: 0.83-1.81) and fully adjusted (hazard ratio=1.16; 95% confidence interval: 0.77-1.76) models; however, in using an additive model, APOL1 high-risk variants were associated with increased cardiovascular mortality. CONCLUSIONS Among African Americans with hypertension-attributed chronic kidney disease, APOL1 risk variants were not associated with an overall risk for cardiovascular disease although some signals for cardiovascular mortality were noted.
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Affiliation(s)
- Teresa K Chen
- From the Divisions of Nephrology (T.K.C., M.E.G., M.J.C.) and General Internal Medicine (L.J.A.), Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD; Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, MD (L.J.A., M.E.G., A.T.); Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (A.T.); Division of Nephrology and Hypertension, Department of Medicine, Georgetown University School of Medicine, Washington, DC (M.S.L.); Basic Research Laboratory, Center for Cancer Research, National Cancer Institute, National Institutes of Health and Leidos Biomedical, Frederick National Laboratory, MD (C.A.W.); and Kidney Health Research Collaborative, Department of Medicine, San Francisco VA Medical Center and University of California (M.M.E.).
| | - Lawrence J Appel
- From the Divisions of Nephrology (T.K.C., M.E.G., M.J.C.) and General Internal Medicine (L.J.A.), Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD; Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, MD (L.J.A., M.E.G., A.T.); Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (A.T.); Division of Nephrology and Hypertension, Department of Medicine, Georgetown University School of Medicine, Washington, DC (M.S.L.); Basic Research Laboratory, Center for Cancer Research, National Cancer Institute, National Institutes of Health and Leidos Biomedical, Frederick National Laboratory, MD (C.A.W.); and Kidney Health Research Collaborative, Department of Medicine, San Francisco VA Medical Center and University of California (M.M.E.)
| | - Morgan E Grams
- From the Divisions of Nephrology (T.K.C., M.E.G., M.J.C.) and General Internal Medicine (L.J.A.), Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD; Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, MD (L.J.A., M.E.G., A.T.); Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (A.T.); Division of Nephrology and Hypertension, Department of Medicine, Georgetown University School of Medicine, Washington, DC (M.S.L.); Basic Research Laboratory, Center for Cancer Research, National Cancer Institute, National Institutes of Health and Leidos Biomedical, Frederick National Laboratory, MD (C.A.W.); and Kidney Health Research Collaborative, Department of Medicine, San Francisco VA Medical Center and University of California (M.M.E.)
| | - Adrienne Tin
- From the Divisions of Nephrology (T.K.C., M.E.G., M.J.C.) and General Internal Medicine (L.J.A.), Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD; Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, MD (L.J.A., M.E.G., A.T.); Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (A.T.); Division of Nephrology and Hypertension, Department of Medicine, Georgetown University School of Medicine, Washington, DC (M.S.L.); Basic Research Laboratory, Center for Cancer Research, National Cancer Institute, National Institutes of Health and Leidos Biomedical, Frederick National Laboratory, MD (C.A.W.); and Kidney Health Research Collaborative, Department of Medicine, San Francisco VA Medical Center and University of California (M.M.E.)
| | - Michael J Choi
- From the Divisions of Nephrology (T.K.C., M.E.G., M.J.C.) and General Internal Medicine (L.J.A.), Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD; Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, MD (L.J.A., M.E.G., A.T.); Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (A.T.); Division of Nephrology and Hypertension, Department of Medicine, Georgetown University School of Medicine, Washington, DC (M.S.L.); Basic Research Laboratory, Center for Cancer Research, National Cancer Institute, National Institutes of Health and Leidos Biomedical, Frederick National Laboratory, MD (C.A.W.); and Kidney Health Research Collaborative, Department of Medicine, San Francisco VA Medical Center and University of California (M.M.E.)
| | - Michael S Lipkowitz
- From the Divisions of Nephrology (T.K.C., M.E.G., M.J.C.) and General Internal Medicine (L.J.A.), Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD; Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, MD (L.J.A., M.E.G., A.T.); Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (A.T.); Division of Nephrology and Hypertension, Department of Medicine, Georgetown University School of Medicine, Washington, DC (M.S.L.); Basic Research Laboratory, Center for Cancer Research, National Cancer Institute, National Institutes of Health and Leidos Biomedical, Frederick National Laboratory, MD (C.A.W.); and Kidney Health Research Collaborative, Department of Medicine, San Francisco VA Medical Center and University of California (M.M.E.)
| | - Cheryl A Winkler
- From the Divisions of Nephrology (T.K.C., M.E.G., M.J.C.) and General Internal Medicine (L.J.A.), Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD; Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, MD (L.J.A., M.E.G., A.T.); Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (A.T.); Division of Nephrology and Hypertension, Department of Medicine, Georgetown University School of Medicine, Washington, DC (M.S.L.); Basic Research Laboratory, Center for Cancer Research, National Cancer Institute, National Institutes of Health and Leidos Biomedical, Frederick National Laboratory, MD (C.A.W.); and Kidney Health Research Collaborative, Department of Medicine, San Francisco VA Medical Center and University of California (M.M.E.)
| | - Michelle M Estrella
- From the Divisions of Nephrology (T.K.C., M.E.G., M.J.C.) and General Internal Medicine (L.J.A.), Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD; Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, MD (L.J.A., M.E.G., A.T.); Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (A.T.); Division of Nephrology and Hypertension, Department of Medicine, Georgetown University School of Medicine, Washington, DC (M.S.L.); Basic Research Laboratory, Center for Cancer Research, National Cancer Institute, National Institutes of Health and Leidos Biomedical, Frederick National Laboratory, MD (C.A.W.); and Kidney Health Research Collaborative, Department of Medicine, San Francisco VA Medical Center and University of California (M.M.E.)
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21
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Ku E, Lipkowitz MS, Appel LJ, Parsa A, Gassman J, Glidden DV, Smogorzewski M, Hsu CY. Strict blood pressure control associates with decreased mortality risk by APOL1 genotype. Kidney Int 2017; 91:443-450. [PMID: 27927600 PMCID: PMC5237400 DOI: 10.1016/j.kint.2016.09.033] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Revised: 09/14/2016] [Accepted: 09/15/2016] [Indexed: 02/06/2023]
Abstract
Although APOL1 high-risk genotype partially accounts for the increased susceptibility of blacks to chronic kidney disease (CKD), whether APOL1 associates differentially with mortality risk remains controversial. Here we evaluate the association between APOL1 genotype and risk of death and determine whether APOL1 status modifies the association between strict versus usual blood pressure control and mortality risk. We performed a retrospective analysis of the African American Study of Kidney Disease and Hypertension trial that randomized black participants with CKD to strict versus usual blood pressure control from 1995 to 2001. This included 682 participants with known APOL1 genotype (157 with high-risk genotype) previously assigned to either strict (mean arterial pressure [MAP] 92 mm Hg or less) versus usual blood pressure control (MAP 102-107 mm Hg) during the trial. During a median follow-up of 14.5 years, risk of death did not differ between individuals with high- versus low-risk APOL1 genotypes (unadjusted hazard ratio 1.00 [95% confidence interval 0.76-1.33]). However, a significant interaction was detected between the APOL1 risk group and blood pressure control strategy. In the APOL1 high-risk group, the risk of death was 42% lower comparing strict versus usual blood pressure control (0.58 [0.35-0.97]). In the APOL1 low-risk group, the risk of death comparing strict versus usual blood pressure control was not significantly different (1.09 [0.84-1.43]). Thus, strict blood pressure control during CKD associates with a lower risk of death in blacks with the high-risk CKD APOL1 genotype. Knowledge of APOL1 status could inform selection of blood pressure treatment targets in black CKD patients.
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Affiliation(s)
- Elaine Ku
- Division of Nephrology, Department of Medicine, University of California, San Francisco, San Francisco, California, USA; Division of Pediatric Nephrology, Department of Pediatrics, University of California, San Francisco, San Francisco, California, USA.
| | - Michael S Lipkowitz
- Division of Nephrology, Department of Medicine, Georgetown University, Washington, DC, USA
| | - Lawrence J Appel
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, Maryland, USA
| | - Afshin Parsa
- Division of Nephrology, Department of Medicine, University of Maryland, Baltimore, Maryland, USA; Department of Medicine, Baltimore VA Medical Center, Baltimore, Maryland, USA
| | - Jennifer Gassman
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio, USA
| | - David V Glidden
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California, USA
| | - Miroslaw Smogorzewski
- Division of Nephrology and Hypertension, Department of Medicine, University of Southern California, Los Angeles, California, USA
| | - Chi-Yuan Hsu
- Division of Nephrology, Department of Medicine, University of California, San Francisco, San Francisco, California, USA
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