Kidney Week

Abstract: FR-PO0648

APOL1 High-Risk Genotypes and Risk of ESKD in Lupus Nephritis: A Systematic Review and Meta-Analysis

Session Information

• Glomerular Diseases: Clinical, Outcomes, and Therapeutics Research - ANCA/FSGS
  October 23, 2026 | Location: Exhibit Hall A, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Glomerular Diseases

• 1402 Glomerular Diseases: Clinical, Outcomes, and Therapeutics

Authors

• Aldana-Pérez, Silvia Estefania, Universidad Simon Bolivar, Barranquilla, Atlantico, Colombia

Silvia Estefania Aldana-Pérez, MD

• Dominguez-Vargas, Alex, Universidad del Norte, Barranquilla, Atlantico, Colombia

Alex Dominguez-Vargas, MD, PhD

• Aroca Martinez, Gustavo, Universidad Simon Bolivar, Barranquilla, Atlantico, Colombia

Gustavo Aroca Martinez, MD, PhD, MPH, FASN

• Moreno-Woo, Ana, Universidad del Norte, Barranquilla, Atlantico, Colombia

Ana Moreno-Woo, MS

• Fang, Luis, Universidad del Norte, Barranquilla, Atlantico, Colombia

Luis Fang, PhD

• Garavito De Egea, Gloria, Universidad del Norte, Barranquilla, Atlantico, Colombia

Gloria Garavito De Egea, MD, PhD

• Egea Bermejo, Eduardo, Universidad del Norte, Barranquilla, Atlantico, Colombia

Eduardo Egea Bermejo, MD, PhD

• Gonzalez Torres, Henry J., Universidad Simon Bolivar, Barranquilla, Atlantico, Colombia

Henry J. Gonzalez Torres, MS, MSc, PhD

Background

Systemic lupus erythematosus is characterized by chronic interferon activation that upregulates apolipoprotein L1 (APOL1) expression. High-risk (HR) APOL1 genotypes have been associated with adverse renal outcomes in lupus nephritis (LN), particularly among individuals of African ancestry. However, the magnitude and consistency of this association remain uncertain.

Methods

We conducted a systematic review and meta-analysis of observational studies evaluating the association between APOL1 genotypes and renal outcomes in LN. PubMed, Embase, and Scopus were systematically searched through November 2024. Eligible studies included patients with LN classified according to APOL1 HR genotypes (2 risk alleles: G1/G1, G1/G2, or G2/G2) versus low-risk genotypes. The primary outcome was end-stage kidney disease (ESKD). Random-effects models using restricted maximum likelihood were applied to estimate pooled odds ratios (ORs) with 95% confidence intervals (CIs). Heterogeneity was assessed using the I² statistic.

Results

Four observational studies comprising 1,885 patients of African ancestry were included. Among them, 321 carried APOL1 HR genotypes and 1,564 carried low-risk genotypes. APOL1 HR genotypes were significantly associated with increased risk of progression to ESKD compared with low-risk genotypes (OR 3.39; 95% CI 2.21–5.22; p<0.001). Between-study heterogeneity was low to moderate (I²=34%). All included studies demonstrated a directionally consistent association between APOL1 HR status and adverse renal outcomes. Chronic kidney disease outcomes were reported heterogeneously and therefore summarized descriptively. No evidence of publication bias was identified by funnel plot inspection or Egger regression testing.

Conclusion

APOL1 HR genotypes are strongly associated with increased risk of ESKD in patients with LN. These findings support APOL1 as a clinically relevant genetic modifier of renal prognosis and highlight its potential role in risk stratification and precision medicine approaches in LN, particularly among patients of African ancestry.