An integrative review of APOL1 kidney disease with a focus on the Brazilian population

Chronic Kidney Disease (CKD) has a global impact on morbidity and mortality, affecting disproportionately Afro-descendants with a risk of 4 to5 times higher compared to non-Afro-descendants. The increased risk is driven by both socioeconomic and biological factors, highlighting the role of APOL1 as a pragmatic example of this scenario. Carriers of the high-risk genotype (two risk alleles) are approximately three times more likely to develop CKD and experience more severe disease progression. Despite the high impact on Afro-descendant health, few studies of APOL1 kidney disease investigated the impact in admixed populations. In this integrative review, we evaluate APOL1 kidney disease globally, with a focus on the Brazilian population. We conducted a comprehensive search on PubMed, Lilacs, and Scielo databases. Publications in English, Spanish, and Portuguese were included, covering the period from the identification of APOL1 G1 and G2 variants in 2010 through October 2025. The initial search found 831 articles, after screening and full-text assessment based on predefined inclusion criteria which only includes original research on African or Afro-descendant populations, 306 articles were included and analyzed. In total, ten Brazilian articles were identified. Brazilian studies highlighted the prevalence of APOL1 risk variants, revealing the presence of G1 and G2 alleles in Afro-Brazilians and their significant role in the onset of CKD, lupus nephritis, and early kidney replacement therapy. The limited number of studies conducted within the Brazilian population underscores an urgent need for further research to tailor strategies in public health policies of APOL1 kidney disease on Afro-Brazilian and admixture populations.