APOL1 Risk Variants, Race, and Progression of Chronic Kidney Disease
APOL1 Risk Variants, Race, and Progression of Chronic Kidney Disease
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DOI：
10.1056/nejmoa1310345
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发表时间：
2013-12-05
影响因子：
158.5
通讯作者：
Appel, Lawrence J.
中科院分区：
文献类型：
--
作者：
Parsa, Afshin;Kao, W. H. Linda;Appel, Lawrence J.
在美国的慢性肾脏疾病患者中，与白人患者相比，黑人患者患终末期肾脏疾病的风险更高。方法在两项研究中，我们研究了载脂蛋白L1(APOL1)基因变异对慢性肾脏疾病进展的影响。在非裔美国人肾脏疾病和高血压研究(AASK)中，我们评估了693名因高血压而患有慢性肾脏疾病的黑人患者。在慢性肾功能不全队列(CRIC)研究中，我们评估了2955名患有慢性肾脏疾病的白人患者和黑人患者(其中46%患有糖尿病)，根据他们是否有2份高危APOL1变异(APOL1高风险组)或0或1份拷贝(APOL1低风险组)。在AASK研究中，主要结果是终末期肾病或血清肌酐水平翻了一番。在CRIC研究中，主要结果是估计的肾小球滤过率(EGFR)的斜率和终末期肾脏疾病的组合或EGFR较基线下降50%。结果在AASK研究中，APOL1高风险组和APOL1低风险组的主要结果分别为581%和36.6%(高危组的风险比为1.88；P
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