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Targeting the Uneven Burden of Kidney Disease on Black Americans - The New York Times

Targeting the Uneven Burden of Kidney Disease on Black Americans - The New York Times

Targeting the Uneven Burden of Kidney Disease on Black Americans - The New York Times
May 17, 2022 3 mins, 18 secs

Kidney specialists have long known that Black Americans are disproportionately affected by kidney disease.

population, they comprise 35 percent of Americans with kidney failure.

Black patients tend to contract kidney disease at younger ages, and damage to their organs often progresses faster.

Many with sub-Saharan ancestry have a copy of a variant of the gene APOL1 inherited from each parent, which puts them at high risk.

Olabisi has a federal grant to test whether baricitinib, a drug that treats rheumatoid arthritis, can help kidney patients with the variants.

Although the variants increase risk, they do not preordain kidney disease.

If someone knows that they have the variants, will they live in fear of kidney failure.

There are as yet no proven ways to reduce the risk of kidney disease in those with two copies of the variants.

Rigorous control of blood pressure — a major risk factor for progression of kidney disease — can be difficult to achieve in those who have the variants.

“Now we know that the reason you can’t get your blood pressure down is because you have APOL1 kidney disease that is ferociously raising your blood pressure,” said Dr.

While it has long been known that kidney failure occurs in African Americans five times as much in as it does in white Americans, “We had never been able to understand all the reasons,” said Dr.

It turns out that the variants rose to a high frequency among people in sub-Saharan Africa because they offer powerful protection against deadly African sleeping sickness, a disease caused by trypanosomes.

It is reminiscent of another gene variant that protects against malaria but causes sickle cell disease in those who inherit two copies.

That variant became prominent in parts of Africa and other areas of the world where malaria is common, but sickle cell variants are much less common than APOL1 risk variants.

About 39 percent of Black Americans have one copy of the gene’s risk variants; another 13 percent, or nearly 5.5 million, have two copies.

Those with two copies are at increased risk for fast progressing kidney disease that often starts in young adulthood.

Approximately 15 percent to 20 percent of those with two copies develop kidney disease in their lifetime.

In contrast, 7.7 percent of Americans with African ancestry have one copy of the sickle cell variant, and 0.3 percent have two copies.

One way to treat kidney disease might be using medicines that block the gene and its variants from acting in the body.

Erika Blacksher, an ethicist at the nonprofit Center for Practical Bioethics in Kansas City, Mo., added that while finding “a treatment that might counteract the effect of the genetic variant is good news,” she worried that social inequities could not be disentangled from the high rate of kidney disease among those with sub-Saharan African ancestry, not all of whom have the APOL1 variant.

They discussed his research project, which involves testing Black Americans and enrolling those with the variant and with kidney disease in a study of the arthritis drug.

Researchers think the variants cause kidney disease only when there is a secondary factor.

But there was no agreement on how APOL1 variants caused kidney disease, so it was not clear what a drug was supposed to block.

Vertex researchers hypothesized that the variants spurred APOL1 proteins to punch holes not just in trypanosomes but also in kidney cells.

Vertex tested the experimental drug in a 13-week study in patients with advanced kidney disease.

In late March, the company announced it would take the next step — a clinical trial that would enroll approximately 66 patients in the first phase, to find the best dose, and 400 in the next phase, to see if the drug could improve kidney functions in patients with the risk variants and kidney damage and protect them from developing kidney failure or dying.

Olabisi said he hoped to test 5,000 Black members of the community for kidney disease with a simple urine test and to use a saliva test to detect APOL1 variants.

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