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APOL1 Risk Variants, Acute Kidney Injury, and Death in Participants With African Ancestry Hospitalized With COVID-19

Adriana M Hung1,2, Shailja C Shah3,4, Alexander G Bick5

  • 1Tennessee Valley Healthcare System, Nashville Campus, Nashville.

JAMA Internal Medicine
|January 28, 2022
PubMed

Insights

Individuals with African ancestry carrying two APOL1 risk variants face higher risks of acute kidney injury (AKI) and death following COVID-19 hospitalization. This association holds true even for those with normal kidney function before infection.

Area of Science:

  • Nephrology
  • Genetics
  • Infectious Diseases

Background:

  • Coronavirus disease 2019 (COVID-19) is a significant risk factor for acute kidney injury (AKI), leading to high mortality rates.
  • Individuals of African ancestry with two copies of apolipoprotein L1 (APOL1) risk variants (G1 or G2) exhibit increased susceptibility to kidney disease.

Purpose of the Study:

  • To investigate the association between APOL1 high-risk genotype and the risk of developing COVID-19-associated AKI and mortality.
  • To determine if APOL1 risk variants influence AKI severity and death in patients hospitalized with COVID-19.

Main Methods:

  • A retrospective cohort study involving 990 veterans of African ancestry hospitalized with COVID-19.
  • Genetic information on APOL1 risk variants was analyzed, comparing the high-risk group (two risk variants) with the low-risk group (one or zero risk variants).
  • Multivariable logistic regression was used to assess the association between APOL1 status and outcomes, adjusting for comorbidities and other risk factors. Subgroup analysis was performed for individuals with normal kidney function.

Main Results:

  • The APOL1 high-risk group (12.6% of participants) showed significantly higher odds of developing AKI (OR, 1.95), increased AKI severity (OR, 2.03), and higher mortality (OR, 2.15) compared to the low-risk group.
  • These associations remained significant even in the subgroup of patients with normal kidney function prior to hospitalization (AKI OR, 1.93).
  • Overall, 39.6% of patients developed AKI, 14% had severe AKI, and 12.3% died.

Conclusions:

  • APOL1 kidney risk variants are significantly associated with an increased risk of AKI, AKI severity, and death in individuals of African ancestry hospitalized with COVID-19.
  • The findings highlight a genetic predisposition to severe kidney outcomes following COVID-19 infection in this population.
  • The increased risk associated with APOL1 variants is evident even in individuals without pre-existing kidney impairment.
Abstract

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