Ma Lijun, Langefeld Carl D, Comeau Mary E, Bonomo Jason A, Rocco Michael V, Burkart John M, Divers Jasmin, Palmer Nicholette D, Hicks Pamela J, Bowden Donald W, Lea Janice P, Krisher Jenna O, Clay Margo J, Freedman Barry I
Department of Internal Medicine, Section on Nephrology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA; Center for Public Health Genomics, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA.
Center for Public Health Genomics, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA; Division of Public Health Sciences, Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA.
Kidney Int. 2016 Aug;90(2):389-395. doi: 10.1016/j.kint.2016.02.032. Epub 2016 May 6.
Relative to European Americans, evidence supports that African Americans with end-stage renal disease (ESRD) survive longer on dialysis. Renal-risk variants in the apolipoprotein L1 gene (APOL1), associated with nondiabetic nephropathy and less subclinical atherosclerosis, may contribute to dialysis outcomes. Here, APOL1 renal-risk variants were assessed for association with dialytic survival in 450 diabetic and 275 nondiabetic African American hemodialysis patients from Wake Forest and Emory School of Medicine outpatient facilities. Outcomes were provided by the ESRD Network 6-Southeastern Kidney Council Standardized Information Management System. Dates of death, receipt of a kidney transplant, and loss to follow-up were recorded. Outcomes were censored at the date of transplantation or through 1 July 2015. Multivariable Cox proportional hazards models were computed separately in patients with nondiabetic and diabetic ESRD, adjusting for the covariates age, gender, comorbidities, ancestry, and presence of an arteriovenous fistula or graft at dialysis initiation. In nondiabetic ESRD, patients with 2 (vs. 0/1) APOL1 renal-risk variants had significantly longer dialysis survival (hazard ratio 0.57), a pattern not observed in patients with diabetes-associated ESRD (hazard ratio 1.29). Thus, 2 APOL1 renal-risk variants are associated with longer dialysis survival in African Americans without diabetes, potentially relating to presence of renal-limited disease or less atherosclerosis.
与欧裔美国人相比，有证据支持患有终末期肾病（ESRD）的非裔美国人在透析治疗下存活时间更长。载脂蛋白L1基因（APOL1）中的肾脏风险变异与非糖尿病肾病及较少的亚临床动脉粥样硬化相关，可能影响透析治疗效果。在此，对来自维克森林大学和埃默里大学医学院门诊设施的450名糖尿病和275名非糖尿病非裔美国血液透析患者，评估APOL1肾脏风险变异与透析生存的相关性。结局数据由ESRD网络6 - 东南肾脏委员会标准化信息管理系统提供。记录死亡日期、接受肾脏移植的日期以及失访情况。结局在移植日期或截至2015年7月1日进行截尾。分别在非糖尿病和糖尿病ESRD患者中计算多变量Cox比例风险模型，并对年龄、性别、合并症、血统以及透析开始时动静脉内瘘或移植物的存在情况等协变量进行调整。在非糖尿病ESRD患者中，携带2个（相对于0/1个）APOL1肾脏风险变异的患者透析生存时间显著更长（风险比0.57），而在糖尿病相关ESRD患者中未观察到这种模式（风险比1.29）。因此，2个APOL1肾脏风险变异与非糖尿病非裔美国人更长的透析生存时间相关，这可能与存在肾脏局限性疾病或较少的动脉粥样硬化有关。
