TY - JOUR
T1 - Patterns of kidney function decline associated with APOL1 genotypes
T2 - Results from AASK
AU - Tin, Adrienne
AU - Grams, Morgan E.
AU - Estrella, Michelle
AU - Lipkowitz, Michael
AU - Greene, Tom H.
AU - Kao, Wen Hong Linda
AU - Li, Liang
AU - Appel, Lawrence J.
N1 - Funding Information:
A.T. was supported by National Institutes of Health (NIH)/National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) grant T32 DK007732. M.E.G. is supported by NIH/NIDDK grant K08DK092287. T.H.G. is supported by NIH/NIDDK grant 5R01DK090046. L.L. is supported by NIH/NIDDK grant 5R01DK090046 and NIH/National Cancer Institute grant P30CA016672.
Publisher Copyright:
© 2016 by the American Society of Nephrology.
PY - 2016
Y1 - 2016
N2 - 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.
AB - 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.
KW - AASK (African American Study of Kidney Disease and Hypertension)
KW - African Americans
KW - Alleles
KW - Epidemiology and outcomes
KW - Follow-Up Studies
KW - Genotype
KW - Humans
KW - Kidney Diseases
KW - chronic kidney disease
KW - genetic renal disease
KW - glomerular filtration rate
KW - hypertension
UR - http://www.scopus.com/inward/record.url?scp=85016932281&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85016932281&partnerID=8YFLogxK
U2 - 10.2215/CJN.12221115
DO - 10.2215/CJN.12221115
M3 - Article
C2 - 27230965
AN - SCOPUS:85016932281
SN - 1555-9041
VL - 11
SP - 1353
EP - 1359
JO - Clinical Journal of the American Society of Nephrology
JF - Clinical Journal of the American Society of Nephrology
IS - 8
ER -