A high-risk genetic variant confers a significantly increased risk of progressive kidney disease in African Americans, at least partly explaining a racial disparity in end-stage renal disease (ESRD)

Analysis of black and white patients in another trial - half with diabetes - showed kidney function declined almost three times as fast in blacks with the high-risk APOL1 profile as compared with whites. "These variants explain, in part, the markedly increased risk of ESRD among black patients, as compared with white patients, regardless of diabetes status," Lawrence J. Appel, MD, of Johns Hopkins University, and colleagues reported. "These results also highlight the need to identify other risk factors that can account for residual disparities in ESRD between black patients and white patients. In the context of previous studies, our results suggest that APOL1 high-risk variants increase the risk of progression of chronic kidney disease among black patients, regardless of the cause," they said. Blacks in the United States have almost double the risk of ESRD compared with whites, even after accounting for differences in socioeconomic and clinical factors.