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Kidney Int. 2016 Aug;90(2):389-395. doi: 10.1016/j.kint.2016.02.032. Epub 2016 May 6.

APOL1 renal-risk genotypes associate with longer hemodialysis survival in prevalent nondiabetic African American patients with end-stage renal disease.

Author information

1
Department of Internal Medicine, Section on Nephrology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA; Center for Public Health Genomics, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA.
2
Center for Public Health Genomics, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA; Division of Public Health Sciences, Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA.
3
Department of Biochemistry, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA.
4
Department of Internal Medicine, Section on Nephrology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA.
5
Center for Public Health Genomics, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA; Department of Biochemistry, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA; Center for Genomics and Personalized Medicine Research, Center for Diabetes Research, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA.
6
Department of Biochemistry, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA; Center for Genomics and Personalized Medicine Research, Center for Diabetes Research, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA.
7
Division of Renal Medicine, Department of Internal Medicine, Emory School of Medicine, Atlanta, Georgia, USA.
8
Southeastern Kidney Council Inc.-ESRD Network 6, Raleigh, North Carolina, USA.
9
Department of Internal Medicine, Section on Nephrology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA; Center for Public Health Genomics, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA; Center for Genomics and Personalized Medicine Research, Center for Diabetes Research, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA. Electronic address: bfreedma@wakehealth.edu.

Abstract

Relative to European Americans, evidence supports that African Americans with end-stage renal disease (ESRD) survive longer on dialysis. Renal-risk variants in the apolipoprotein L1 gene (APOL1), associated with nondiabetic nephropathy and less subclinical atherosclerosis, may contribute to dialysis outcomes. Here, APOL1 renal-risk variants were assessed for association with dialytic survival in 450 diabetic and 275 nondiabetic African American hemodialysis patients from Wake Forest and Emory School of Medicine outpatient facilities. Outcomes were provided by the ESRD Network 6-Southeastern Kidney Council Standardized Information Management System. Dates of death, receipt of a kidney transplant, and loss to follow-up were recorded. Outcomes were censored at the date of transplantation or through 1 July 2015. Multivariable Cox proportional hazards models were computed separately in patients with nondiabetic and diabetic ESRD, adjusting for the covariates age, gender, comorbidities, ancestry, and presence of an arteriovenous fistula or graft at dialysis initiation. In nondiabetic ESRD, patients with 2 (vs. 0/1) APOL1 renal-risk variants had significantly longer dialysis survival (hazard ratio 0.57), a pattern not observed in patients with diabetes-associated ESRD (hazard ratio 1.29). Thus, 2 APOL1 renal-risk variants are associated with longer dialysis survival in African Americans without diabetes, potentially relating to presence of renal-limited disease or less atherosclerosis.

KEYWORDS:

APOL1; African Americans; diabetes mellitus; end-stage kidney disease; hemodialysis; survival

PMID:
27157696
PMCID:
PMC4946964
DOI:
10.1016/j.kint.2016.02.032
[Indexed for MEDLINE]
Free PMC Article

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