Among patients of African ancestry hospitalized with COVID-19, those with an apolipoprotein L1 (APOL1) high-risk genotype have increased risks for acute kidney injury (AKI) and death, according to new study findings.

In the retrospective study of 990 Black veterans hospitalized with COVID-19, 125 patients (12.6%) had 2 copies of APOL1 variants G1 or G2. AKI developed in 51.2% of this APOL1 high-risk group and 24 (19%) died, Adriana M. Hung, MD, MPH, of Tennessee Valley Healthcare System, Vanderbilt University, Nashville, Tennessee, and colleagues reported in JAMA Internal Medicine.

Compared with the low-risk group who had 1 or 0 risk variants, the APOL1 high-risk group had significant 2.0-fold increased odds of both AKI overall and more severe AKI stages as well as 2.2-fold increased odds of death in a fully adjusted model, the investigators reported. They were also 2.2-fold more likely to display proteinuria of 1+ or more on admission. Even among those with normal kidney function at baseline (estimated glomerular filtration rate of 60 mL/min/1.73 m2 or higher), the APOL1 high- vs low-risk group had significant 1.9-, 2.1-, and 2.5-fold increased odds of AKI, severe AKI, and death, respectively.

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A 2021 study presented at the National Kidney Foundation Spring Clinical Meetings found similar results using a cohort from Ochsner Health.

“Our findings suggest that genetic risk assessment can inform COVID-19 kidney risk prognostication in individuals with African ancestry,” Dr Hung’s team stated. “Because APOL1 RVs are highly prevalent in the population with African ancestry, studies evaluating the role of existing and novel therapies are needed to reduce poor outcomes in this population.”

The 990 adults from the Million Veteran Program were predominantly male (91.4%) with a median age of 68 years. In the full cohort, 392 (39.6%) patients developed AKI, 141 (14%) developed stages 2 or 3 AKI, 28 (3%) required dialysis, and 122 (12.3%) died. AKI was defined as a 0.3 mg/dL or 50% increase in serum creatinine levels from baseline. Patients with vs without AKI were significantly more likely to require mechanical ventilation (29% vs 5%), vasopressors (22% vs 2%), and to die (26% vs 3%).

Disclosure: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.


Hung AM, Shah SC, Bick AG, et al; for the 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. Published online January 28, 2022. doi:10.1001/jamainternmed.2021.8538