Patterns of kidney function decline associated with APOL1 genotypes: Results from AASK

Adrienne Tin, Morgan E. Grams, Michelle Estrella, Michael Lipkowitz, Tom H. Greene, Wen Hong Linda Kao, Liang Li, Lawrence J. Appel

Research output: Contribution to journalArticlepeer-review

11 Scopus citations


Background and objectives Trajectories of eGFR in patients with CKD are highly variable. Only a subset of patients with CKD experiences a steady decline in eGFR. The objective of our study was to investigate whether eGFR trajectory patterns differ by APOL1 risk status. Design, setting, participants, & measurements Our study was a longitudinal observational study of 622 participants in the African American Study of Kidney Disease and Hypertension with APOL1 genotyping and sufficient follow-up for estimating GFR trajectories. The predictor was APOL1 high-risk status (having two copies of theG1 orG2 risk alleles) versus low-risk status (zero or one copy of the risk alleles), and the outcomewas four eGFR trajectory patterns on the basis of the joint probabilities of linearity and progression: steady decline, unsteady decline, steady stable, and unsteady stable. Results Over amedian follow-up of 9 years, 24.0% of participants experienced steady eGFR decline, 25.9%had an unsteady decline, 25.6% were steady and stable, and 24.6% were unsteady but stable. Those experiencing steady decline had lower eGFR and higher urine protein-to-creatinine ratio at baseline than participants with the other eGFR trajectory patterns. The APOL1 high-risk group was associated with a greater odds for the steady decline pattern than the APOL1 low-risk group (unadjusted odds ratio, 2.45; 95% confidence interval, 1.62 to 3.69). This association remained significant after adjusting for demographic factors, baseline eGFR, urine proteinto-creatinine ratio, treatment assignment, and follow-up time (adjusted odds ratio, 1.59; 95% confidence interval, 1.00 to 2.52). Conclusions Among patients with CKD attributed to hypertension, those with the APOL1 high-risk genotype were more likely to experience a steady decline trajectory in eGFR than those without the APOL1 high-risk genotype. These findings suggest a persistent underlying pathophysiologic process in those patients with the APOL1 high-risk genotype.

Original languageEnglish (US)
Pages (from-to)1353-1359
Number of pages7
JournalClinical Journal of the American Society of Nephrology
Issue number8
StatePublished - 2016


  • AASK (African American Study of Kidney Disease and Hypertension)
  • African Americans
  • Alleles
  • Epidemiology and outcomes
  • Follow-Up Studies
  • Genotype
  • Humans
  • Kidney Diseases
  • chronic kidney disease
  • genetic renal disease
  • glomerular filtration rate
  • hypertension

ASJC Scopus subject areas

  • Epidemiology
  • Critical Care and Intensive Care Medicine
  • Nephrology
  • Transplantation


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