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About SickKids

December 19, 2013

Study finds African-Americans with chronic kidney disease at higher risk for end-stage renal disease

By Erin Collett

A new study published in The New England Journal of Medicine  found that among patients in the United States with chronic kidney disease, African-American patients are at increased risk for end-stage renal disease, compared to patients of European descent. Dr. Rulan Parekh, co-investigator of the study, and Staff Physician in Nephrology at The Hospital for Sick Children (SickKids) worked with the lead researchers at John Hopkins University and the University of Maryland.

The new study is built on previous research led by Parekh, which suggested an increased risk of end-stage renal disease among African-Americans, a high-risk group for progressive kidney disease. When a patient reaches end-stage renal disease, they require lifelong dialysis unless they get a kidney transplant.

For this current research, two studies were conducted to examine the effects of variants in the gene apolipoprotein L1 (APOLI1) on the progression of chronic kidney disease. The first study evaluated 693 adult African-American patients with chronic kidney disease attributed to high blood pressure and the second evaluated 2955 adult patients with chronic kidney disease, 46 per cent of whom had diabetes.

Researchers concluded that renal high-risk variants in APOL1 were associated with an increased risk of progression of chronic kidney disease among African-American patients, even among those with well-controlled blood pressure. These variants may explain, in part, the noticeably increased risk of end-stage renal disease among African-American patients, regardless of diabetes status.

“The risk of progression was two times higher in carriers of the gene APOL1 than non carriers and persisted even after adequate blood pressure management,” says Parekh. “Further work is needed to determine if genetic testing can tailor therapy for kidney disease.”

The study also highlights the need to identify other risk factors that can account for remaining differences in end-stage renal disease among African-American patients and patients with European descent. Regardless of the cause, APOL1 high-risk variants significantly increase the risk of progression of chronic kidney disease.