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Abstract: SA-PO625

Clinician Attitudes Toward Use of APOL1 Genetic Testing in Clinical Practice

Session Information

Category: Genetic Diseases of the Kidney

  • 803 Genetic Epidemiology and Other Genetic Studies of Common Kidney Diseases

Authors

  • Umeukeje, Ebele, Vanderbilt University Medical Center, Vanderbilt Center for Kidney Disease, Nashville, Tennessee, United States
  • Burke, Wylie, University of Washington, Seattle, Washington, United States
  • Cavanaugh, Kerri L., Vanderbilt University Medical Center, Vanderbilt Center for Kidney Disease, Nashville, Tennessee, United States
  • Fullerton, Stephanie M, University of Washington, Seattle, Washington, United States
  • Wilson, James G., University of Mississippi Medical Center, Jackson, Mississippi, United States
  • Young, Bessie A., University of Washington, VA Puget Sound Health Care System, Kidney Research Institute, Seattle, Washington, United States
Background

Apolipoprotein L1 (APOL1) high-risk variants are common among African Americans (AA) and are associated with a 7-10 fold higher risk of non-diabetic endstage renal disease (ESRD). However, there are gaps in knowledge regarding the clinical implication of APOL1 variants in part because associated effects on risk in combination with co-morbidities or environmental exposures are not fully established. The objective of this study is to describe clinicians’ views of APOL1 genetic testing in clinical practice.

Methods

As part of an ongoing study of stakeholder views regarding APOL1 genetic testing in AA, we conducted key informant interviews with primary care (N=13) and nephrology (N=14) clinicians in Seattle WA, Nashville TN, and Jackson MS. Interviews assessed clinicians’ views about the use of APOL1 genetic testing in clinical care.

Results

Clinicians were recruited from different practice settings (63% in Academic centers; 26% in private practice; and 11% in the VA and other settings), and 78% of them provide care to a significant proportion of AA patients (≥ 25%). Dominant themes included possible increased monitoring and motivation of patients with risk factors (e.g. hypertension, family history) vs. possible over or under treatment, increased cost, stigmatization and increased psychological stress. Exemplar quotes: “In terms of getting people to change their lifestyles, for some people, having this risk might help that. It might just freak them out. I don’t really know. I think those are all – I think we’re in uncharted territory clinically, actually”; “We want to make sure we’re following the data and not jumping to conclusions about when to apply something that may still be in the phase of further interpretation in the science.”

Conclusion

Our results suggest that clinicians hold uncertain views on the use of APOL1 testing to guide clinical practice. Further research is needed to determine the impact of testing on clinical outcomes especially in patients with ESRD risk factors.

Funding

  • Other NIH Support