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

• Published in: Clinical journal of the American Society of Nephrology 2021-12, Vol.16 (12), p.1790-1796
• Main Authors: Larsen, Christopher P, Wickman, Terrance J, Braga, Juarez R, Matute-Trochez, Luis A, Hasty, Anna E, Buckner, Lyndsey R, Arthur, John M, Haun, Randy S, Velez, Juan Carlos Q
• Format: Article
• Language: English
• Subjects: Acute Kidney Injury - genetics; Apolipoprotein L1 - genetics; Apolipoproteins - genetics; Black or African American - genetics; COVID-19 - genetics; Genotype; Humans; Original; Risk Factors; SARS-CoV-2
• ISSN: 1555-9041; 1555-905X
• DOI: 10.2215/CJN.01070121

Black Americans have a higher incidence of kidney disease compared with populations that do not have recent African ancestry. Two risk variants in the are responsible for a portion of this higher risk. We sought to assess the odds of AKI conferred by risk alleles in patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Black Americans who tested positive for coronavirus disease 2019 (COVID-19) were genotyped to determine risk allele status. We assessed the incidence of AKI, persistent AKI, and AKI requiring KRT within 21 days of the PCR-based diagnosis. Outcomes were adjusted for age, sex, body mass index, hypertension, eGFR, and use of angiotensin-converting enzyme inhibitor/angiotensin receptor blocker. In total, 126 cases of SARS-CoV-2 infection were included within a 5-month period, with 16 (13%) and 110 (87%) cases with two and zero/one high-risk alleles, respectively. AKI occurred in 11 (69%) patients with two high-risk alleles and 39 (35%) patients with zero/one high-risk alleles (adjusted odds ratio, 4.41; 95% confidence interval, 1.11 to 17.52; =0.04). Persistent AKI occurred in eight (50%) patients with two high-risk alleles and 21 (19%) of those with zero/one high-risk alleles (adjusted odds ratio, 3.53; 95% confidence interval, 1.8 to 11.57; =0.04). AKI KRT occurred in four (25%) of those with two high-risk alleles and eight (7%) of those with zero/one high-risk alleles (adjusted odds ratio, 4.99; 95% confidence interval, 1.02 to 24.4, =0.05). high-risk alleles are associated with greater odds of AKI in Black American patients with COVID-19.