Blood test predicts kidney failure risk to Black Americans years before onset
A new study from Penn Medicine identifies disease risk among those carrying the high-risk APOL1 gene variant before kidney function declines.
2 min. read
A new blood test can identify which individuals of African ancestry carrying high-risk APOL1 gene variants are most likely to develop kidney failure, years before clinical disease becomes apparent. Findings on the new test, developed by a team from the Perelman School of Medicine, are published in Nature Medicine.
“What has been missing is a way to identify early disease activity before we see changes in standard clinical measures,” says senior author Katalin Susztak, a professor in renal electrolyte and hypertension and director of the Penn-CHOP Kidney Innovation Center. “This approach allows us to intervene early enough and lessen the severity, or even prevent, kidney disease in some patients.”
African Americans develop kidney failure at nearly four times the rate of those of European ancestry, driven in part by variants in the APOL1 gene. The APOL1 gene helps protect against certain infections, but some versions of it can also increase the risk of serious kidney disease. Until now there has been no reliable way to determine who is truly at risk before kidney function begins to decline.
Researchers analyzed blood samples from more than 850 people of African ancestry enrolled in the Penn Medicine BioBank, all of whom carried APOL1 high-risk variants and had normal kidney function at the start of the study. Using a small panel of circulating proteins measured from a routine blood draw, the team developed a risk score that predicts the likelihood of kidney failure, significant decline in kidney function, or death over the following ten years.
The differences between groups were substantial. More than 60% of individuals in the highest-risk category experienced renal failure requiring the need for dialysis or transplantation within ten years, compared to fewer than 1% in the lowest-risk group.
The proteins included in the score are linked to pathways involved in kidney injury and fibrosis, suggesting that the test captures early biological changes that precede measurable loss of kidney function.
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