Genetics contribute to increased risk for end-stage renal disease for African Americans with chronic kidney disease

In the United States, African Americans have approximately twice the risk of end-stage renal disease compared to white Americans, despite a similar prevalence in earlier stages of chronic kidney disease. A large study co-authored by George Washington University (GW) researcher Dominic Raj, M.D., identifies factors that mediate differences in the progression of chronic kidney disease between black patients and white patients, as well as among black patients, in order to reduce the excess burden of end-stage renal disease and its complications in black patients.

The findings, published in the New England Journal of Medicine, examines the effects of variants in the gene encoding apolipoprotein L1 (APOL1) on the progression of chronic kidney disease, according to whether patients have two copies of high-risk APOL1 variants (APOL1 high-risk group) or zero or one copy (APOL1 low-risk group). Renal risk variants in APOL1 were associated with higher rates of end-stage and progression of chronic kidney disease that were observed in black patients as compared with , regardless of diabetes status.

The findings came from two large National Institutes of Health-funded study cohorts of nearly 5,000 individuals with kidney disease, including the African American Study of Kidney Disease and Hypertension (AASK) and the Chronic Renal Insufficiency Cohort (CRIC) study. The study was supported, in part, by a recent R0-1 grant awarded to Raj.

"This study is a unique example of the importance of collaboration across institutions to deliver high quality science," said Raj, director of the division of nephrology and professor of medicine at the GW School of Medicine and Health Sciences.

The AASK study, which enrolled African American patients with attributed to hypertension, found that kidney failure occurred in 58.1 percent of patients in the APOL1 high-risk group and 36.6 percent of those in the APOL1 low-risk group. In the CRIC study, kidney function decline was greater among black patients in the APOL1 high-risk group, but it was similar among in the APOL1 low-risk group and white patients, regardless of their diabetes status.

"This study shows that APOL1 variant confers risk for progression of kidney diseases, independent of blood pressure control and diabetic status in African Americans. Chronic is one of the most glaring examples of racial and ethnic disparities in health outcomes in the United States," said Raj. "While this is an important contribution that furthers our understanding for the cause for such disparity, this study also highlights the need for further studies that could lead to risk stratification and early and targeted interventions."

More information: "APOL1 Risk Variants, Race, and Progression of Chronic Kidney Disease," www.nejm.org/doi/full/10.1056/NEJMoa1310345

Related Stories

New innovations in clinical science

Nov 09, 2013

A variety of recent studies highlight new and innovative research efforts that could help improve individuals' kidney health. Below are the findings of some of these studies, which are being presented at ASN Kidney Week 2013 ...

Gene linked to worsening kidney disease in African-Americans

Nov 21, 2010

In African Americans with kidney disease related to hypertension (high blood pressure), a common gene variant is associated with a sharply increased risk of progressive kidney disease, according to a study presented at the ...

Recommended for you

US Ebola labs, parts for clinic arrive in Liberia

44 minutes ago

U.S. mobile Ebola labs should be up and running in Liberia this week, and American troops have broken ground for a field hospital, as the international community races to increase the ability to care for ...

Ebola-hit Liberia staring into the abyss

5 hours ago

With its collapsed health service, sick and poorly equipped security forces and broken economy, Ebola-hit Liberia finds itself on the brink of complete societal breakdown, experts warn.

Dallas hospital monitoring patient for Ebola

5 hours ago

A patient in a Dallas hospital is showing signs of the Ebola virus and is being kept in strict isolation with test results pending, hospital officials said Monday.

'Deadly diarrhea' rates nearly doubled in 10 years

14 hours ago

Infections with the intestinal superbug C. difficile nearly doubled from 2001 to 2010 in U.S. hospitals without noticeable improvement in patient mortality rates or hospital lengths of stay, according to a study of 2.2 mi ...

User comments