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APOL1 Risk Variants and Acute Kidney Injury in Black Americans with COVID-19

Christopher P Larsen1, Terrance J Wickman2, Juarez R Braga3

  • 1Arkana Laboratories, Little Rock, Arkansas chris.larsen@arkanalabs.com.

Clinical Journal of the American Society of Nephrology : CJASN
|January 11, 2023
PubMed

Insights

Black Americans with two APOL1 high-risk alleles had significantly higher odds of developing acute kidney injury (AKI) after COVID-19 infection. These findings highlight APOL1

Area of Science:

  • Nephrology
  • Genetics
  • Infectious Diseases

Background:

  • Black Americans exhibit a higher incidence of kidney disease.
  • Two APOL1 gene risk variants contribute to this increased risk.
  • The impact of APOL1 risk alleles on acute kidney injury (AKI) in COVID-19 patients is under investigation.

Purpose of the Study:

  • To assess the association between APOL1 risk alleles and the odds of developing AKI.
  • To evaluate the incidence of persistent AKI and AKI requiring kidney replacement therapy (KRT) in COVID-19 patients.
  • To investigate the role of APOL1 in AKI among Black Americans with SARS-CoV-2 infection.

Main Methods:

  • Genotyping for APOL1 risk alleles in Black American patients diagnosed with COVID-19.
  • Assessment of AKI incidence, persistent AKI, and AKI requiring KRT within 21 days of diagnosis.
  • Statistical adjustments for age, sex, BMI, hypertension, eGFR, and ACEi/ARB use.

Main Results:

  • Patients with two APOL1 high-risk alleles showed a 4.41-fold increased odds of AKI (P=0.04).
  • Persistent AKI occurred in 50% of patients with two high-risk alleles versus 19% with zero/one allele (aOR, 3.53; P=0.04).
  • AKI requiring KRT was observed in 25% of patients with two high-risk alleles (aOR, 4.99; P=0.05).

Conclusions:

  • APOL1 high-risk alleles are significantly associated with increased odds of AKI in Black American patients with COVID-19.
  • These genetic factors may exacerbate kidney injury severity in the context of SARS-CoV-2 infection.
  • Findings underscore the importance of genetic predisposition in understanding kidney disease disparities.
Abstract

Keywords:
COVID-19acute kidney injuryacute renal failureapolipoprotein L1genetic renal disease

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