Re-analyzed APOL1 kidney data support new ethics of ‘race’

Abstract

OBJECTIVES (1) To examine 'race' in acute and chronic kidney disease under similar conditions, and (2) to encourage further study of implied cofactors and an international approach to end misuse of 'race'. METHODS We re-analyzed data from United States veterans, (1) comparing outcomes after removing 'race correction' from legacy estimated glomerular filtration rates and (2) graphing data to explore more subtle relationships. We hypothesized factors confounding the link between kidney disease and apolipoprotein L1 gene variants, including cofactors implied and controlled by veteran status. RESULTS Studies of veterans minimized 'racial' disparity in chronic kidney disease, suggesting an effect of starting conditions, including Armed Services entry requirements and equitable access to healthcare. Apolipoprotein L1 "high-risk" and N264K+ gene variants may be proxies for 'race', with gradients of effect due to colorism. CONCLUSIONS Under equitable conditions, comparable kidney disease outcomes should be the expected norm for all, regardless of 'race', ethnicity, or nationality. Discouraging misuse of 'race' in medical research and healthcare is an actionable population health initiative with potentially high impact but low effort and cost. ABBREVIATIONS AKI = acute kidney injury, APOL1 = apolipoprotein L1, BS = bad science, CKD = chronic kidney disease, COVID = coronavirus disease, eGFR = estimated GFR, FSGS = focal segmental glomerulosclerosis, GFR = glomerular filtration rate, HR = high risk, LR = low risk, IRB = institutional review board, KF = kidney failure, MDRD = Modification of Diet in Renal Disease, NASEM = National Academies of Science Engineering and Medicine, OR = odds ratio, RR = relative risk, RV = risk variant, SDOH = social determinants of health, VA = Veterans Administration.