Association Between APOL1 Genotype and Kidney Diseases and Annual Kidney Function Change: A Systematic Review and Meta-Analysis of the Prospective Studies.
Association Between APOL1 Genotype and Kidney Diseases and Annual Kidney Function Change: A Systematic Review and Meta-Analysis of the Prospective Studies.
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DOI：
10.2147/ijnrd.s294191
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发表时间：
2021
影响因子：
2
通讯作者：
Patzer RE
中科院分区：
文献类型：
--
作者：
Jagannathan R;Rajagopalan K;Hogan J;Hart A;Newell KA;Pastan SO;Patzer RE
载脂蛋白L1基因（APOL 1）中的两种编码风险变体是最近非洲血统患者中大部分肾脏疾病过度风险的基础。APOL 1高风险基因型与慢性肾脏病（CKD）和终末期肾脏病（ESRD）风险之间关系的强度和一致性并不一致。对前瞻性研究进行系统性综述和荟萃分析，评估APOL 1基因型与成人发生CKD、ESRD以及CKD与ESRD风险的相关性。对MEDLINE、EMBASE和Google Scholar进行了系统检索，以获得评估APOL 1基因型与CKD、ESRD以及从CKD进展为ESRD之间相关性的前瞻性研究。次要分析是通过APOL 1基因状态评价每年的肾功能变化。随机效应模型用于估计关注结局的合并风险比（RR）和加权平均差异。在4.4至25年的随访期内，检索到10例前瞻性研究。与低危APOL 1基因型相比，高危APOL 1基因型与CKD的发病率（RR：1.41[95%CI：1.14-1.75]）、CKD向ESRD的进展（RR：1.70[95%CI：1.44; 2.01]）相关。高危型APOL 1基因型与ESRD的发生率无明显相关性。此外，与低风险APOL 1基因型状态相比，高风险APOL 1基因型与年eGFR下降的边际减少相关（-0.55 [95% CI：-0.94至-0.16]）mL/min/1.73 m2。总之，携带APOL 1高风险基因型的非洲裔美国人患CKD和ESRD的风险增加。鉴于APOL 1风险等位基因在非洲血统的个体中很常见，约18%的非洲裔美国人携带高风险等位基因，这些发现强调了可能受益于APOL 1筛查和制定文化适当干预措施的患者亚组的潜在识别。
Two coding risk variants in the Apo L1 gene (APOL1) underlie most of the excess risk for kidney diseases in recent African ancestry patients. Strength and consistency of the relationship between APOL1 high-risk genotypes and the risk of chronic kidney diseases (CKD) and end-stage renal disease (ESRD) are not uniform. To conduct a systematic review and meta-analysis of prospective studies assessing the association of APOL1 genotypes and the risk of developing CKD, ESRD, and CKD to ESRD in adults. Systematic search of MEDLINE, EMBASE, and Google Scholar was performed for prospective studies assessing the associations between APOL1 genotypes and CKD, ESRD, and progression from CKD to ESRD. Secondary analyses were to evaluate the annual kidney function change by APOL1 gene status. Random effects models were used to estimate pooled risk ratios (RRs) and weighted mean differences for outcomes of interest. The search yield 10 prospective during a follow-up period ranging from 4.4 to 25 years. The high-risk APOL1 genotype was associated with the incidence of CKD (RR:1.41[95% CI: 1.14–1.75]), the progression from CKD to ESRD (RR: 1.70[95% CI:1.44; 2.01]) compared with the low-risk APOL1 genotype. There was no appreciable association between high-risk APOL1 genotype with the incidence of ESRD. Furthermore, high-risk APOL1 genotype was associated with a marginal decrement in the annual eGFR decline (−0.55[95% CI: −0.94 to −0.16]) mL/min/1.73m2 compared with low-risk APOL1 genotype status. In summary, African Americans carrying APOL1 high-risk genotypes are at increased risk of developing CKD and ESRD. Given that the APOL1 risk alleles are common among individuals with African ancestry, with ~18% of African Americans carrying high-risk alleles, these findings highlight the potential identification of subgroups of patients who may benefit from APOL1 screening and developing culturally-appropriate interventions.