Apolipoprotein L1 and Chronic Kidney Disease Risk in Young Potential Living Kidney Donors.
Apolipoprotein L1 and Chronic Kidney Disease Risk in Young Potential Living Kidney Donors.
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DOI：
10.1097/sla.0000000000002174
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发表时间：
2018-06
影响因子：
9
通讯作者：
Lewis CE
中科院分区：
文献类型：
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作者：
Locke JE;Sawinski D;Reed RD;Shelton B;MacLennan PA;Kumar V;Mehta S;Mannon RB;Gaston R;Julian BA;Carr JJ;Terry JG;Kilgore M;Massie AB;Segev DL;Lewis CE
为年轻潜在的活体供肾者开发一种新的慢性肾脏病（CKD）风险预测工具。活体肾脏捐献者的选择实践已经从检查个体风险因素发展到结合多种特征的风险计算器。由于长期数据有限和缺乏遗传信息，目前的风险工具在年轻的潜在活体肾脏捐献者中缺乏准确性，特别是非洲裔美国人（AAs）。我们从纵向队列研究CARDIA中确定了一组无肾脏捐献绝对禁忌症的年轻人（18-30岁）。确定CKD的风险相关性（eGFR <60 mL/min/1.73m2），并分配加权点以计算风险评分。确定了3，438名健康成人;平均年龄24.8岁; 48.3% AA;中位随访时间24.9年（IQR：24.5-25.2）。对于18岁的青少年，即使没有基线临床和遗传异常，25年预测的CKD风险也因种族和性别而异;风险为0.30%，欧洲裔美国人（EA）女性，0.52%，AA女性，0.90%，AA男性。在18岁的AA患者中，携带载脂蛋白L1基因（APOL 1）肾风险变异体且基线无异常者，25年风险显著增加：女性为1.46%，男性为2.53%;在携带两种APOL 1肾风险变异体且基线异常者中，25年风险更高：女性为2.53%-6.23%，男性为4.35%-10.58%。年轻的AA是CKD的最高风险，APOL 1肾脏风险变异导致了部分风险。了解年轻AA潜在活体肾脏供体的遗传特征，在基线健康特征的背景下，可能有助于告知候选人的选择和咨询。
To develop a novel chronic kidney disease (CKD) risk prediction tool for young potential living kidney donors. Living kidney donor selection practices have evolved from examining individual risk factors to a risk calculator incorporating multiple characteristics. Due to limited long-term data and lack of genetic information, current risk tools lack precision among young potential living kidney donors, particularly African Americans (AAs). We identified a cohort of young adults (18–30 years) with no absolute contraindication to kidney donation from the longitudinal cohort study CARDIA. Risk associations for CKD (eGFR <60 mL/min/1.73m2) were identified and assigned weighted points to calculate risk scores. 3,438 healthy adults were identified; mean age 24.8 years; 48.3% AA; median follow-up 24.9 years (IQR: 24.5–25.2). For 18-year-olds, 25-year projected CKD risk varied by ethnicity and gender even without baseline clinical and genetic abnormalities; risk was 0.30% for European American (EA) women, 0.52% for EA men, 0.52% for AA women, 0.90% for AA men. Among 18-year-old AAs with apolipoprotein L1 gene (APOL1) renal-risk variants without baseline abnormalities, 25-year risk significantly increased: 1.46% for women and 2.53% for men; among those with two APOL1 renal-risk variants and baseline abnormalities, 25-year risk was higher: 2.53%–6.23% for women and 4.35%–10.58% for men. Young AAs were at highest risk for CKD, and APOL1 renal-risk variants drove some of this risk. Understanding the genetic profile of young AA potential living kidney donors in the context of baseline health characteristics may help to inform candidate selection and counseling.