Race, APOL1 Risk, and eGFR Decline in the General Population
Race, APOL1 Risk, and eGFR Decline in the General Population
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DOI：
10.1681/asn.2015070763
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发表时间：
2016-09-01
影响因子：
13.6
通讯作者：
Coresh, Josef
中科院分区：
文献类型：
--
作者：
Grams, Morgan E.;Rebholz, Casey M.;Coresh, Josef
APOL1 高危基因型存在于美国约 13% 的黑人中，是 CKD 人群肾功能下降的危险因素。目前尚不清楚一般人群是否需要进行基因筛查。我们评估了基于人群的社区动脉粥样硬化风险 (ARIC) 研究参与者中 APOL1 高风险状态的预后，包括与 eGFR 下降的关联、eGFR 下降的变异性以及相关不良健康事件（AKI、ESRD、高血压、糖尿病、心血管疾病、ESRD 前期和总住院率以及死亡率）。从 1987-1989 年（基线）到 2011-2013 年跟踪的 15,140 名 ARIC 参与者中，75.3% 是白人，21.5% 是黑人/APOL1 低风险，3.2% 是黑人/APOL1 高风险。在人口调整分析中，黑人发生所有评估的不良健康事件的风险较高；然而，在根据合并症和社会经济状况进行调整的分析中，黑人仅患高血压、糖尿病和终末期肾病的风险较高。在黑人中，在完全调整的分析中，APOL1 高风险基因型仅与 ESRD 较高风险相关。黑人种族和 APOL1 高风险状态与 eGFR 更快下降有关（P
The APOL1 high-risk genotype, present in approximately 13% of blacks in the United States, is a risk factor for kidney function decline in populations with CKD. It is unknown whether genetic screening is indicated in the general population. We evaluated the prognosis of APOL1 high-risk status in participants in the population-based Atherosclerosis Risk in Communities (ARIC) study, including associations with eGFR decline, variability in eGFR decline, and related adverse health events (AKI, ESRD, hypertension, diabetes, cardiovascular disease, pre-ESRD and total hospitalization rate, and mortality). Among 15,140 ARIC participants followed from 1987-1989 (baseline) to 2011-2013, 75.3% were white, 21.5% were black/APOL1 low-risk, and 3.2% were black/APOL1 high-risk. In a demographic-adjusted analysis, blacks had a higher risk for all assessed adverse health events; however, in analyses adjusted for comorbid conditions and socioeconomic status, blacks had a higher risk for hypertension, diabetes, and ESRD only. Among blacks, the APOL1 high-risk genotype associated only with higher risk of ESRD in a fully adjusted analysis. Black race and APOL1 high-risk status were associated with faster eGFR decline (P