Kidney Week

Abstract: SA-OR09

APOL1 Risk Variants, AKI, and Death in Black Veterans with COVID-19

Session Information

• COVID-19 and Kidney Diseases: From Bedside to Bench
  November 06, 2021 | Location: Simulive, Virtual Only
  Abstract Time: 04:30 PM - 06:00 PM

Category: Coronavirus (COVID-19)

• 000 Coronavirus (COVID-19)

Authors

• Hung, Adriana, Vanderbilt University Medical Center, Nashville, Tennessee, United States

Adriana Hung, MD, MPH

• Shah, Shailja C., University of California San Diego, La Jolla, California, United States

Shailja C. Shah,

• Bick, Alexander, Vanderbilt University Medical Center, Nashville, Tennessee, United States

Alexander Bick,

• Yu, Zhihong, Vanderbilt University Medical Center, Nashville, Tennessee, United States

Zhihong Yu,

• Chen, Hua-Chang, Vanderbilt University Medical Center, Nashville, Tennessee, United States

Hua-Chang Chen,

• Tao, Ran, Vanderbilt University Medical Center, Nashville, Tennessee, United States

Ran Tao,

• Akwo, Elvis A., Vanderbilt University Medical Center, Nashville, Tennessee, United States

Elvis A. Akwo,

• Chung, Cecilia P., Vanderbilt University Medical Center, Nashville, Tennessee, United States

Cecilia P. Chung,

• Matheny, Michael Edwin, Vanderbilt University Medical Center, Nashville, Tennessee, United States

Michael Edwin Matheny,

• Susztak, Katalin, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, United States

Katalin Susztak,

• Robinson-Cohen, Cassianne, Vanderbilt University Medical Center, Nashville, Tennessee, United States

Cassianne Robinson-Cohen,

• Tuteja, Sony, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, United States

Sony Tuteja,

• Siew, Edward D., Vanderbilt University Medical Center, Nashville, Tennessee, United States

Edward D. Siew,

Group or Team Name

• Million Veteran Program

Background

Health disparities exist in rates of acute kidney injury (AKI) and death related to COVID-19. Black patients with two copies of apolipoprotein L1 (APOL1) variants G1 or G2 have significantly increased rates of renal disease. It is unknown whether APOL1 is associated with an increased risk for AKI in COVID-19 infection.

Methods

We performed a retrospective study of 990 Black patients in the VA Million Veteran Program hospitalized with COVID-19 between March 2020 and January 2021. The primary exposure was having 2 APOL1 risk variants (APOL1 high-risk group), compared to having 1 or 0 risk variants (APOL1 low-risk group). The primary outcome was AKI. The secondary outcomes were AKI severity stages and death. We performed a subgroup analysis in individuals with eGFR> 60 ml/min/1.73m2.

Results

392 (39.6%) patients developed AKI, 28 (7%) required dialysis and 122 (12.3%) died. Patients categorized as APOL1 high-risk group had a significantly higher risk of AKI (adjusted odds ratio [OR] 1.98; 95% confidence interval [CI]: 1.29-3.05; p=0.002), higher AKI severity stages (OR 2.06; 95% CI: 1.39-3.04; p<0.001) and death (OR 2.15; 95% CI: 1.23-3.67; p=0.006). The association with AKI persisted in the subgroup with normal kidney function (OR 1.92; 95% CI: 1.15-3.22; p=0.01). Figure 1. shows the proportion of patients by AKI stages according to APOL1 risk group.

Conclusion

APOL1 renal risk variants were associated with higher risk of AKI, AKI severity, and death in Black Veterans hospitalized with COVID-19, even amongst individuals with prior normal kidney function. We identify a specific genetic contribution to COVID-19 health disparities.

Fig. 1 Proportion of patients experiencing AKI stages severity by APOL1 risk group

Funding

• Veterans Affairs Support