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(HealthNewsDigest.com) – Long overdue, the medical community is increasingly turning its attention toward understanding and addressing racial and ethnic health disparities. We – a SLUCare physician and a patient at SSM Health Saint Louis University Hospital – write to shed light on kidney disease, an area where racially based health disparities are stark and where more research is needed so that we can change this pattern.
A Genetic Clue
As they look more closely at these disparities, researchers across the country are reassessing how doctors factor in race when treating people with chronic kidney disease.
African ancestry is associated with an increased risk of kidney failure in the general population and following living kidney donation. Moreover, kidney transplants from deceased donors with African ancestry have an increased risk of graft failure compared to organs from non-African ancestral donors.
Recent breakthroughs in medical genetics have revealed that a portion of kidney failure affecting African Americans is mediated by genes – and those genetic variants, not race – account for that increased risk.
Kidney risk variants in a gene called apolipoprotein L1 (APOL1) are present only in persons of African ancestry. Inheriting two risk variants – one from each parent – is associated with an increased risk of kidney failure, and this high-risk genotype is present in approximately 15% of African Americans.
Scientists are actively seeking to understand how APOL1 risk variants damage the kidney and develop novel treatments to stop the damage. However, currently, there are no treatments for APOL1-related kidney disease, though individuals with high-risk genotypes may benefit from better blood pressure control and other kidney risk factor management.
Importantly, though, APOL1 high-risk genotypes do not destine a person to develop kidney disease. Rather, additional genetic and/or environmental risk factors are likely required for disease progression. These additional risk factors may include environmental and social determinants of health, as well as biological factors.
Categorizing race as a biological construct, rather than a social one, contributes to health care disparities in kidney treatment and transplant, including organ acceptance practices.
An Opportunity
Despite critical needs for new information to understand kidney disease risk and find targeted solutions, there are disparities in research participation in the African American community.
As a researcher and a participant in the national study, “APOL1 Long-term Kidney Transplantation Outcomes Network (APOLLO),” aimed at changing these trends, we write to encourage African Americans in the St. Louis region to consider participating in new research studies to help improve the understanding of chronic kidney disease and transplant outcomes.
SLUCare doctors at SSM Health Saint Louis University Hospital’s transplant center are one of 13 lead centers coordinating with transplant programs across the nation in the NIH-funded APOLLO study. Eligible participants include living kidney donors, recipients of a kidney transplant from an eligible living or deceased donor with recent African ancestry, and recipients of multiple organs transplanted simultaneously. Researchers seek to enroll at least 2,614 donor-recipient pairs.
Researchers will examine whether the genes of a kidney donor and their transplant recipient play a role in transplant outcomes. Living donors will be followed for the health of their remaining kidney. That information could change the way doctors consider race when they make a decision about accepting an organ donor and care for patients after surgery.
In addition, the SLU team, in partnership with Mid-America Transplant Foundation, has launched a pilot project in their St. Louis kidney care clinics offering APOL1 gene typing to African American patients and assessing attitudes about genetic testing and kidney care.
Grounded in feedback from community advisors, we believe the national APOLLO and our local APOL1 studies provide models of vitally needed, patient-centered clinical science. Coupled with precision medicine techniques, these studies have a strong potential to overcome critical disparities in kidney disease risk assessment and care.
To learn more about these studies, call 314-257-3760 or email [email protected].
Krista Lentine, M.D., Ph.D., is a professor of medicine at Saint Louis University School of Medicine and medical director of living kidney donation at SSM Health Saint Louis University Hospital. She serves as the Mid-America Transplant/Jane A. Beckman endowed chair and co-director of clinical research in the Abdominal Transplant Center at SSM Health Saint Louis University Hospital.
Deryl Cunningham is a patient advocate, kidney transplant recipient, and research study participant at SSM Health Saint Louis University Hospital.