APOL1 Risk Variants, Race, and Progression of Chronic Kidney Disease

被引：591

作者：

Parsa, Afshin ^{[1
]}

Kao, W. H. Linda ^{[2
,4
]}

Xie, Dawei ^{[5
,6
]}

Astor, Brad C. ^{[7
]}

Li, Man ^{[2
]}

Hsu, Chi-yuan ^{[8
,21
]}

Feldman, Harold I. ^{[5
,6
]}

Parekh, Rulan S. ^{[9
,10
]}

Kusek, John W. ^{[11
]}

Greene, Tom H. ^{[13
]}

Fink, Jeffrey C. ^{[1
]}

Anderson, Amanda H. ^{[5
,6
]}

Choi, Michael J. ^{[3
]}

Wright, Jackson T., Jr. ^{[14
]}

Lash, James P. ^{[15
]}

Freedman, Barry I. ^{[16
]}

Ojo, Akinlolu ^{[17
]}

Winkler, Cheryl A. ^{[12
]}

Raj, Dominic S. ^{[18
]}

Kopp, Jeffrey B. ^{[11
]}

He, Jiang ^{[20
]}

Jensvold, Nancy G. ^{[21
]}

Tao, Kaixiang ^{[5
,6
]}

Lipkowitz, Michael S. ^{[19
]}

Appel, Lawrence J. ^{[2
,3
,4
]}

机构：

[1] Univ Maryland, Sch Med, Baltimore, MD 21201 USA

[2] Johns Hopkins Bloomberg Sch Publ Hlth, Baltimore, MD USA

[3] Johns Hopkins Univ, Sch Med, Baltimore, MD USA

[4] Johns Hopkins Univ, Welch Ctr Prevent Epidemiol & Clin Res, Baltimore, MD USA

[5] Univ Penn, Perelman Sch Med, Philadelphia, PA 19104 USA

[6] Univ Penn, Ctr Clin Epidemiol & Biostat, Philadelphia, PA 19104 USA

[7] Univ Wisconsin, Sch Med & Publ Hlth, Madison, WI 53706 USA

[8] Univ Calif San Francisco, San Francisco, CA 94143 USA

[9] Univ Toronto, Hosp Sick Children, Toronto, ON M5G 1X8, Canada

[10] Univ Hlth Network, Toronto, ON, Canada

[11] NIDDK, NIH, Bethesda, MD 20892 USA

[12] NCI, Ctr Canc Res, SAIC Frederick, Frederick, MD USA

[13] Univ Utah, Sch Med, Salt Lake City, UT USA

[14] Case Western Reserve Univ, Sch Med, Cleveland, OH 44106 USA

[15] Univ Illinois, Coll Med, Chicago, IL USA

[16] Wake Forest Sch Med, Winston Salem, NC USA

[17] Univ Michigan, Sch Med, Ann Arbor, MI USA

[18] George Washington Univ, Sch Med, Washington, DC USA

[19] Georgetown Univ, Sch Med, Washington, DC USA

[20] Tulane Univ, Sch Publ Hlth & Trop Med, New Orleans, LA USA

[21] Kaiser Permanente No Calif, Oakland, CA USA

来源：

NEW ENGLAND JOURNAL OF MEDICINE | 2013年 / 369卷 / 23期

关键词：

STAGE RENAL-DISEASE; BASE-LINE CHARACTERISTICS; RACIAL-DIFFERENCES; INSUFFICIENCY COHORT; FUNCTION DECLINE; GENE; MYH9; GFR; PARTICIPANTS; CKD;

D O I：

10.1056/NEJMoa1310345

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

BackgroundAmong patients in the United States with chronic kidney disease, black patients are at increased risk for end-stage renal disease, as compared with white patients. MethodsIn two studies, we examined the effects of variants in the gene encoding apolipoprotein L1 (APOL1) on the progression of chronic kidney disease. In the African American Study of Kidney Disease and Hypertension (AASK), we evaluated 693 black patients with chronic kidney disease attributed to hypertension. In the Chronic Renal Insufficiency Cohort (CRIC) study, we evaluated 2955 white patients and black patients with chronic kidney disease (46% of whom had diabetes) according to whether they had 2 copies of high-risk APOL1 variants (APOL1 high-risk group) or 0 or 1 copy (APOL1 low-risk group). In the AASK study, the primary outcome was a composite of end-stage renal disease or a doubling of the serum creatinine level. In the CRIC study, the primary outcomes were the slope in the estimated glomerular filtration rate (eGFR) and the composite of end-stage renal disease or a reduction of 50% in the eGFR from baseline. ResultsIn the AASK study, the primary outcome occurred in 58.1% of the patients in the APOL1 high-risk group and in 36.6% of those in the APOL1 low-risk group (hazard ratio in the high-risk group, 1.88; P<0.001). There was no interaction between APOL1 status and trial interventions or the presence of baseline proteinuria. In the CRIC study, black patients in the APOL1 high-risk group had a more rapid decline in the eGFR and a higher risk of the composite renal outcome than did white patients, among those with diabetes and those without diabetes (P<0.001 for all comparisons). ConclusionsRenal risk variants in APOL1 were associated with the higher rates of end-stage renal disease and progression of chronic kidney disease that were observed in black patients as compared with white patients, regardless of diabetes status. (Funded by the National Institute of Diabetes and Digestive and Kidney Diseases and others.)

引用

页码：2183 / 2196

页数：14

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