APOL1 renal-risk genotypes associate with longer hemodialysis survival in prevalent nondiabetic African American patients with end-stage renal disease

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.

Keywords: APOL1; African Americans; diabetes mellitus; end-stage kidney disease; hemodialysis; survival.

MeSH terms

  • Aged
  • Apolipoprotein L1
  • Apolipoproteins / genetics*
  • Black or African American / genetics*
  • Diabetic Nephropathies / genetics
  • Diabetic Nephropathies / mortality*
  • Diabetic Nephropathies / therapy
  • Female
  • Genotype
  • Humans
  • Kidney Failure, Chronic / genetics
  • Kidney Failure, Chronic / mortality*
  • Kidney Failure, Chronic / therapy
  • Kidney Transplantation
  • Lipoproteins, HDL / genetics*
  • Male
  • Middle Aged
  • Renal Dialysis*
  • Risk Factors
  • Survival Analysis
  • White People / genetics


  • APOL1 protein, human
  • Apolipoprotein L1
  • Apolipoproteins
  • Lipoproteins, HDL