TY - JOUR
T1 - Race, APOL1 Risk Variants, and Clinical Outcomes among Older Adults
T2 - The ARIC Study
AU - Chen, Teresa K.
AU - Coresh, Josef
AU - Daya, Natalie
AU - Ballew, Shoshana H.
AU - Tin, Adrienne
AU - Crews, Deidra C.
AU - Grams, Morgan E.
N1 - Funding Information:
Teresa K. Chen was supported by a Clinician Scientist Career Development Award from Johns Hopkins University and is supported by a George M. O'Brien Center for Kidney Research Pilot and Feasibility Grant from Yale University (under Award No. NIH/NIDDK P30DK079310) and NIH/NIDDK K08DK117068. Morgan E. Grams is supported by NIH/NIDDK R01DK108803. The ARIC study has been funded in whole or in part with federal funds from the National Heart, Lung, and Blood Institute, National Institutes of Health (NIH), Department of Health and Human Services, under Contract Nos. HHSN268201700001I, HHSN268201700002I, HHSN268201700003I, HHSN268201700005I, and HHSN268201700004I. Funding for laboratory testing and biospecimen collection at ARIC Visit 6 was supported by Grant No. R01DK089174 from the National Institute of Diabetes and Digestive and Kidney Diseases of the NIH. Some of the data reported here were supplied by the U.S. Renal Data System. The interpretation and reporting of these data are the responsibility of the authors and in no way should be seen as an official policy or interpretation of the U.S. government.
Funding Information:
The authors thank the staff and participants of the Atherosclerosis Risk in Communities (ARIC) study for their important contributions. Teresa K. Chen was supported by a Clinician Scientist Career Development Award from Johns Hopkins University and is supported by a George M. O'Brien Center for Kidney Research Pilot and Feasibility Grant from Yale University (under Award No. NIH/NIDDK P30DK079310) and NIH/NIDDK K08DK117068. Morgan E. Grams is supported by NIH/NIDDK R01DK108803. The ARIC study has been funded in whole or in part with federal funds from the National Heart, Lung, and Blood Institute, National Institutes of Health (NIH), Department of Health and Human Services, under Contract Nos. HHSN268201700001I, HHSN268201700002I, HHSN268201700003I, HHSN268201700005I, and HHSN268201700004I. Funding for laboratory testing and biospecimen collection at ARIC Visit 6 was supported by Grant No. R01DK089174 from the National Institute of Diabetes and Digestive and Kidney Diseases of the NIH. Some of the data reported here were supplied by the U.S. Renal Data System. The interpretation and reporting of these data are the responsibility of the authors and in no way should be seen as an official policy or interpretation of the U.S. government. The authors have declared no conflicts of interest for this article. Teresa K. Chen had full access to the data in the study and takes responsibility for the accuracy of the data analysis. Concept and design: Chen and Grams. Acquisition, analysis, or interpretation of data: All authors. Drafting of the manuscript: Chen. Critical revision of the manuscript for important intellectual content: All authors. Statistical analysis: Chen. Administrative, technical, or material support: Chen and Daya. Supervision: Grams. The NIH funded the ARIC study but had no role in the design, analysis, interpretation, or preparation of this manuscript.
Publisher Copyright:
© 2020 The American Geriatrics Society
PY - 2021/1
Y1 - 2021/1
N2 - BACKGROUND/OBJECTIVES: APOL1 high-risk genotypes confer an increased risk for kidney disease, but their clinical significance among older adults remains unclear. We aimed to determine whether APOL1 genotype status (high risk = 2 risk alleles; low risk = 0–1 risk alleles) and self-reported race (Black; White) are associated with number of hospitalizations, incident chronic kidney disease (CKD), end-stage renal disease (ESRD), and mortality among older adults participating in a community-based cohort study. DESIGN: Observational longitudinal cohort study. SETTING: The Atherosclerosis Risk in Communities (ARIC) study. PARTICIPANTS: Community-dwelling older adults (mean age = 75.8 years; range = 66–90 years). RESULTS: Among 5,564 ARIC participants (78.2% White, 19.1% APOL1 low-risk Black, and 2.7% APOL1 high-risk Black), the proportion with creatinine and cystatin C–based estimated glomerular filtration rate (eGFRCrCys) below 60 mL/min/1.73 m2 at baseline was 40.6%, 34.8%, and 43.2%, respectively. Over a mean follow-up of 5.1 years, APOL1 high-risk Blacks had a 2.67-fold higher risk for ESRD compared with low-risk Blacks (95% confidence interval [CI] = 1.05–6.79) in models adjusted for age and sex. This association was no longer significant upon further adjustment for baseline eGFRCrCys and albuminuria (hazard ratio [HR] = 1.08; 95% CI =.39–2.96). Rate of hospitalizations and risks of mortality and incident CKD did not differ significantly by APOL1 genotype status. Compared with Whites, Blacks had 1.85-fold and 3.45-fold higher risks for incident CKD and ESRD, respectively, in models adjusted for age, sex, eGFRCrCys, and albuminuria. These associations persisted after additional adjustments for clinical/socioeconomic factors and APOL1 genotype (incident CKD: HR = 1.38; 95% CI = 1.06–1.81; ESRD: HR = 3.20; 95% CI = 1.16–8.86). CONCLUSION: Among older Black adults, APOL1 high-risk genotypes were associated with lower kidney function and therefore higher risk of ESRD. Racial disparities in incident kidney disease persisted in older age and were not fully explained by APOL1.
AB - BACKGROUND/OBJECTIVES: APOL1 high-risk genotypes confer an increased risk for kidney disease, but their clinical significance among older adults remains unclear. We aimed to determine whether APOL1 genotype status (high risk = 2 risk alleles; low risk = 0–1 risk alleles) and self-reported race (Black; White) are associated with number of hospitalizations, incident chronic kidney disease (CKD), end-stage renal disease (ESRD), and mortality among older adults participating in a community-based cohort study. DESIGN: Observational longitudinal cohort study. SETTING: The Atherosclerosis Risk in Communities (ARIC) study. PARTICIPANTS: Community-dwelling older adults (mean age = 75.8 years; range = 66–90 years). RESULTS: Among 5,564 ARIC participants (78.2% White, 19.1% APOL1 low-risk Black, and 2.7% APOL1 high-risk Black), the proportion with creatinine and cystatin C–based estimated glomerular filtration rate (eGFRCrCys) below 60 mL/min/1.73 m2 at baseline was 40.6%, 34.8%, and 43.2%, respectively. Over a mean follow-up of 5.1 years, APOL1 high-risk Blacks had a 2.67-fold higher risk for ESRD compared with low-risk Blacks (95% confidence interval [CI] = 1.05–6.79) in models adjusted for age and sex. This association was no longer significant upon further adjustment for baseline eGFRCrCys and albuminuria (hazard ratio [HR] = 1.08; 95% CI =.39–2.96). Rate of hospitalizations and risks of mortality and incident CKD did not differ significantly by APOL1 genotype status. Compared with Whites, Blacks had 1.85-fold and 3.45-fold higher risks for incident CKD and ESRD, respectively, in models adjusted for age, sex, eGFRCrCys, and albuminuria. These associations persisted after additional adjustments for clinical/socioeconomic factors and APOL1 genotype (incident CKD: HR = 1.38; 95% CI = 1.06–1.81; ESRD: HR = 3.20; 95% CI = 1.16–8.86). CONCLUSION: Among older Black adults, APOL1 high-risk genotypes were associated with lower kidney function and therefore higher risk of ESRD. Racial disparities in incident kidney disease persisted in older age and were not fully explained by APOL1.
KW - APOL1
KW - apolipoprotein L1
KW - chronic kidney disease
KW - end-stage renal disease
KW - mortality
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U2 - 10.1111/jgs.16797
DO - 10.1111/jgs.16797
M3 - Article
C2 - 32894582
AN - SCOPUS:85090307557
SN - 0002-8614
VL - 69
SP - 155
EP - 163
JO - Journal of the American Geriatrics Society
JF - Journal of the American Geriatrics Society
IS - 1
ER -