article · Clinical Kidney Journal
APOL1 genetic risk variants are strongly associated with kidney disease in people of African ancestry, but their broader cardiovascular and haemodynamic effects are not well understood, especially among dialysis patients. A cross-sectional study in Pretoria evaluated 115 Black African adults receiving maintenance haemodialysis to examine connections between APOL1 variants and blood pressure measures, including systolic, diastolic, mean arterial, and pulse pressure. Genetic testing showed that 53.0 percent had zero risk alleles, 36.5 percent had one, and 10.4 percent had two. Carrying APOL1 risk variants was consistently linked to significantly lower pulse pressure, even after adjusting for age, sex, and antihypertensive medication burden. Adjusted models also showed significantly lower systolic blood pressure in risk allele carriers, whereas diastolic and mean arterial pressures showed no consistent associations, pointing to a distinct pattern of reduced arterial pulsatility.
APOL1 genetic variants are major drivers of kidney disease in people of African ancestry, but their influence on the cardiovascular system remains unclear. Showing that risk allele carriers experience lower pulse pressure and altered arterial pulsatility helps clinicians and researchers better understand cardiovascular profiles in kidney failure, which is increasingly relevant as new APOL1-targeted treatments enter clinical testing.
This early-stage observational research could inform the design and monitoring of clinical trials for emerging APOL1-targeted therapeutics, assisting pharmaceutical developers and translational researchers in tracking cardiovascular biomarkers. Because the findings are derived from a single cross-sectional study without interventional testing, the research is at a foundational stage and far from clinical or commercial implementation.
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Abstract Background APOL1 risk variants are strongly associated with kidney disease in individuals of recent African ancestry, but their haemodynamic effects remain incompletely characterised, particularly in African dialysis populations. We evaluated the association between APOL1 variants and blood pressure phenotypes in a South African haemodialysis cohort. Methods In this cross-sectional study, 115 adults receiving maintenance haemodialysis in Pretoria were included. All participants were self-identified Black Africans. APOL1 genotyping (G1: rs73885319, rs60910145; G2: rs71785313) was performed, and genetic models were analysed as additive, dominant, and recessive. Pre-dialysis blood pressure was defined as the mean of five consecutive measurements. Outcomes included systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), and pulse pressure (PP). Associations were assessed using linear mixed-effects models with dialysis site as a random effect, with sequential adjustment for age, sex, and antihypertensive class burden. Results APOL1 risk allele distribution was 53.0% zero, 36.5% one, and 10.4% two alleles. There were no consistent associations between APOL1 genotype and SBP, DBP, or MAP in univariate analyses. In multivariable models, SBP was significantly lower in APOL1 risk allele carriers under additive and dominant models. In contrast, PP was consistently lower in APOL1 risk allele carriers and remained significant after full adjustment (additive model, one vs zero: β -7.772, 95% CI -13.009 to -2.535, P = 0.004; dominant model: β -7.69 95% CI -12.622 to -2.757, P = 0.003). No consistent associations were observed for DBP or MAP. Conclusions In this cohort of Black African haemodialysis patients, APOL1 risk variants were associated with lower PP and, after adjustment, lower SBP, without differences in DBP or MAP. These findings suggest a distinct haemodynamic phenotype characterised by reduced arterial pulsatility and highlight the need for further mechanistic and prospective studies, particularly in the context of emerging APOL1-targeted therapies.
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DOI: 10.1093/ckj/sfag295
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