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APOL1 Risk Variants, Acute Kidney Injury, and Death in Participants With African Ancestry Hospitalized With COVID-19 From the Million Veteran Program.

Publication ,  Journal Article
Hung, AM; Shah, SC; Bick, AG; Yu, Z; Chen, H-C; Hunt, CM; Wendt, F; Wilson, O; Greevy, RA; Chung, CP; Suzuki, A; Ho, Y-L; Akwo, E; Zhou, J ...
Published in: JAMA Intern Med
April 1, 2022

IMPORTANCE: Coronavirus disease 2019 (COVID-19) confers significant risk of acute kidney injury (AKI). Patients with COVID-19 with AKI have high mortality rates. OBJECTIVE: Individuals with African ancestry with 2 copies of apolipoprotein L1 (APOL1) variants G1 or G2 (high-risk group) have significantly increased rates of kidney disease. We tested the hypothesis that the APOL1 high-risk group is associated with a higher-risk of COVID-19-associated AKI and death. DESIGN, SETTING, AND PARTICIPANTS: This retrospective cohort study included 990 participants with African ancestry enrolled in the Million Veteran Program who were hospitalized with COVID-19 between March 2020 and January 2021 with available genetic information. EXPOSURES: The primary exposure was having 2 APOL1 risk variants (RV) (APOL1 high-risk group), compared with having 1 or 0 risk variants (APOL1 low-risk group). MAIN OUTCOMES AND MEASURES: The primary outcome was AKI. The secondary outcomes were stages of AKI severity and death. Multivariable logistic regression analyses adjusted for preexisting comorbidities, medications, and inpatient AKI risk factors; 10 principal components of ancestry were performed to study these associations. We performed a subgroup analysis in individuals with normal kidney function prior to hospitalization (estimated glomerular filtration rate ≥60 mL/min/1.73 m2). RESULTS: Of the 990 participants with African ancestry, 905 (91.4%) were male with a median (IQR) age of 68 (60-73) years. Overall, 392 (39.6%) patients developed AKI, 141 (14%) developed stages 2 or 3 AKI, 28 (3%) required dialysis, and 122 (12.3%) died. One hundred twenty-five (12.6%) of the participants were in the APOL1 high-risk group. Patients categorized as APOL1 high-risk group had significantly higher odds of AKI (adjusted odds ratio [OR], 1.95; 95% CI, 1.27-3.02; P = .002), higher AKI severity stages (OR, 2.03; 95% CI, 1.37-2.99; P < .001), and death (OR, 2.15; 95% CI, 1.22-3.72; P = .007). The association with AKI persisted in the subgroup with normal kidney function (OR, 1.93; 95% CI, 1.15-3.26; P = .01). Data analysis was conducted between February 2021 and April 2021. CONCLUSIONS AND RELEVANCE: In this cohort study of veterans with African ancestry hospitalized with COVID-19 infection, APOL1 kidney risk variants were associated with higher odds of AKI, AKI severity, and death, even among individuals with prior normal kidney function.

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Published In

JAMA Intern Med

DOI

EISSN

2168-6114

Publication Date

April 1, 2022

Volume

182

Issue

4

Start / End Page

386 / 395

Location

United States

Related Subject Headings

  • Veterans
  • Risk Factors
  • Retrospective Studies
  • Middle Aged
  • Male
  • Humans
  • Hospitalization
  • Female
  • Cohort Studies
  • COVID-19
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Hung, A. M., Shah, S. C., Bick, A. G., Yu, Z., Chen, H.-C., Hunt, C. M., … VA Million Veteran Program COVID-19 Science Initiative, . (2022). APOL1 Risk Variants, Acute Kidney Injury, and Death in Participants With African Ancestry Hospitalized With COVID-19 From the Million Veteran Program. JAMA Intern Med, 182(4), 386–395. https://doi.org/10.1001/jamainternmed.2021.8538
Hung, Adriana M., Shailja C. Shah, Alexander G. Bick, Zhihong Yu, Hua-Chang Chen, Christine M. Hunt, Frank Wendt, et al. “APOL1 Risk Variants, Acute Kidney Injury, and Death in Participants With African Ancestry Hospitalized With COVID-19 From the Million Veteran Program.JAMA Intern Med 182, no. 4 (April 1, 2022): 386–95. https://doi.org/10.1001/jamainternmed.2021.8538.
Hung AM, Shah SC, Bick AG, Yu Z, Chen H-C, Hunt CM, et al. APOL1 Risk Variants, Acute Kidney Injury, and Death in Participants With African Ancestry Hospitalized With COVID-19 From the Million Veteran Program. JAMA Intern Med. 2022 Apr 1;182(4):386–95.
Hung, Adriana M., et al. “APOL1 Risk Variants, Acute Kidney Injury, and Death in Participants With African Ancestry Hospitalized With COVID-19 From the Million Veteran Program.JAMA Intern Med, vol. 182, no. 4, Apr. 2022, pp. 386–95. Pubmed, doi:10.1001/jamainternmed.2021.8538.
Hung AM, Shah SC, Bick AG, Yu Z, Chen H-C, Hunt CM, Wendt F, Wilson O, Greevy RA, Chung CP, Suzuki A, Ho Y-L, Akwo E, Polimanti R, Zhou J, Reaven P, Tsao PS, Gaziano JM, Huffman JE, Joseph J, Luoh S-W, Iyengar S, Chang K-M, Casas JP, Matheny ME, O’Donnell CJ, Cho K, Tao R, Susztak K, Robinson-Cohen C, Tuteja S, Siew ED, VA Million Veteran Program COVID-19 Science Initiative. APOL1 Risk Variants, Acute Kidney Injury, and Death in Participants With African Ancestry Hospitalized With COVID-19 From the Million Veteran Program. JAMA Intern Med. 2022 Apr 1;182(4):386–395.

Published In

JAMA Intern Med

DOI

EISSN

2168-6114

Publication Date

April 1, 2022

Volume

182

Issue

4

Start / End Page

386 / 395

Location

United States

Related Subject Headings

  • Veterans
  • Risk Factors
  • Retrospective Studies
  • Middle Aged
  • Male
  • Humans
  • Hospitalization
  • Female
  • Cohort Studies
  • COVID-19