APOL1 kidney disease: conclusions from a Kidney Disease: Improving Global Outcomes (KDIGO) Controversies Conference

Akinlolu O Ojo; Dwomoa Adu; Kate Bramham; Barry I Freedman; Rasheed A Gbadegesin; Titilayo O Ilori; Nichole Jefferson; Opeyemi A Olabisi; Katalin Susztak; Bessie A Young; Michael Cheung; Jennifer M King; Morgan E Grams; Michel Jadoul; Ifeoma I Ulasi; Conference Participants

doi:10.1016/j.kint.2025.05.017

APOL1 kidney disease: conclusions from a Kidney Disease: Improving Global Outcomes (KDIGO) Controversies Conference

Kidney Int. 2025 Nov;108(5):763-779. doi: 10.1016/j.kint.2025.05.017. Epub 2025 Jun 23.

Authors

Collaborators

Conference Participants:
Angela Opokua Afonope, Godfred Akyea-Darkwah, Jaime Albright, Joshua Albright, Sampson Antwi, Gloria Ashuntantang, Vincent Boima, Kirk N Campbell, Ewurabena Aniniwa Darkwah, Victor Ezeibe, June Fabian, Lori-Ann Fisher, David J Friedman, Keisha L Gibson, Raquel C Greer, Sumi Hidaka, Taler B K Jefferson, Krista L Lentine, Sophie Limou, Dominique E Martin, Kevin Mott, Marva M Moxey-Mims, Saraladevi Naicker, Precil Diego Miranda de Menezes Neves, Abdou Niang, Irene L Noronha, Rulan S Parekh, Afshin Parsa, Brian L Rayner, Simone Sanna-Cherchi, John R Sedor, Aude Servais, Barry Shingwenyana, Bernard Sintim, Junelle P Speller, Ernest Sumaili Kiswaya, Ifeoma I Ulasi, Fernanda Sales Luiz Vianna

Affiliations

¹ Department of Internal Medicine, University of Kansas School of Medicine, Kansas City, Kansas, USA; Department of Public Health, University of Kansas School of Medicine, Kansas City, Kansas, USA. Electronic address: aojo@kumc.edu.
² Department of Medicine and Therapeutics, School of Medicine, College of Health Sciences, University of Ghana, Accra, Ghana.
³ Department of Renal Medicine, King's College London, London, UK.
⁴ Department of Internal Medicine, Section on Nephrology, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA.
⁵ Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina, USA.
⁶ Division of Nephrology, Chobanian and Avedisian School of Medicine, Boston Medical Center, Boston University, Boston, Massachusetts, USA.
⁷ Community Advisory Council, APOL1 Long-Term Kidney Transplantation Outcomes Network, Dallas, Texas, USA.
⁸ Division of Nephrology, Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA; Duke Molecular Physiology Institute, Duke University School of Medicine, Durham, North Carolina, USA.
⁹ Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA; Department of Genetics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
¹⁰ Office of Healthcare Equity, Department of Medicine, Division of Nephrology, University of Washington, Seattle, Washington.
¹¹ KDIGO, Brussels, Belgium.
¹² Department of Medicine, New York University Langone School of Medicine, New York, New York, USA.
¹³ Division of Nephrology, Cliniques Universitaires Saint Luc, Université Catholique de Louvain, Brussels, Belgium.
¹⁴ Renal Unit, Department of Medicine, College of Medicine, University of Nigeria, Ituku-Ozalla, Enugu, Nigeria. Electronic address: ifeomaulasi@yahoo.co.uk.

PMID: 40582702
DOI: 10.1016/j.kint.2025.05.017

Abstract

In people of African ancestry, apolipoprotein L1 gene (APOL1) variants have been identified as causing increased risk of progressive chronic kidney disease (CKD). In April of 2024, Kidney Disease: Improving Global Outcomes (KDIGO) convened a Controversies Conference on APOL1 Kidney Disease in Accra, Ghana. The goals of the conference were to review and discuss current evidence and controversies on APOL1 kidney disease, including naming, epidemiology, pathophysiology, APOL1 testing, treatment, and future research needs. Participants considered various terminologies for diseases related to APOL1 risk variants (such as APOL1-mediated or -induced kidney disease) and had highest support for using APOL1 kidney disease to describe kidney pathologies associated with the APOL1 G1 and G2 risk variants. Clinically, the term APOL1 kidney disease can be used on its own or as an overall category of kidney disease, with further specification added as needed (for example, APOL1 kidney disease, focal segmental glomerulosclerosis). Given that there are currently no established treatments for APOL1 kidney disease, and APOL1 genotype results are not by themselves actionable, there is insufficient evidence to guide recommendations for APOL1 population screening or routine testing. However, genotyping can be an important clinical consideration for individuals to inform risk stratification, frequency of follow-up, living kidney donation, as well as clinical trial eligibility. Key areas of need and strategies for future research were delineated and are reported here.

Keywords: chronic kidney disease; genetic testing; glomerulosclerosis.

Publication types

Conference Proceedings
Review

MeSH terms

Apolipoprotein L1* / genetics
Black People / genetics
Disease Progression
Genetic Predisposition to Disease
Humans
Renal Insufficiency, Chronic* / diagnosis
Renal Insufficiency, Chronic* / epidemiology
Renal Insufficiency, Chronic* / genetics
Renal Insufficiency, Chronic* / therapy
Risk Factors
Terminology as Topic

Substances

APOL1 protein, human
Apolipoprotein L1

Grants and funding

R01 DK134347/DK/NIDDK NIH HHS/United States