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Grobe N, Scheiber J, Zhang H, Garbe C, Wang X. Omics and Artificial Intelligence in Kidney Diseases. ADVANCES IN KIDNEY DISEASE AND HEALTH 2023; 30:47-52. [PMID: 36723282 DOI: 10.1053/j.akdh.2022.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 10/28/2022] [Accepted: 11/16/2022] [Indexed: 01/20/2023]
Abstract
Omics applications in nephrology may have relevance in the future to improve clinical care of kidney disease patients. In a short term, patients will benefit from specific measurement and computational analyses around biomarkers identified at various omics-levels. In mid term and long term, these approaches will need to be integrated into a holistic representation of the kidney and all its influencing factors for individualized patient care. Research demonstrates robust data to justify the application of omics for better understanding, risk stratification, and individualized treatment of kidney disease patients. Despite these advances in the research setting, there is still a lack of evidence showing the combination of omics technologies with artificial intelligence and its application in clinical diagnostics and care of patients with kidney disease.
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Affiliation(s)
| | | | | | - Christian Garbe
- Frankfurter Innovationszentrum Biotechnologie, Frankfurt am Main, Germany
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Tan XY, Borden C, Roberts MB, Mazzola S, Tan QKG, Fatica R, Simon J, Calle J, Taliercio J, Dell K, Provenzano LF, Deitzer D, Rincon-Choles H, Mehdi A, Lioudis M, Poggio ED, Nakhoul G, Nurko S, Ashour T, Bou Matar RN, Kwon C, Stephany B, Thomas G, Cheng YW, Leingang D, Alsadah A, Maditz R, Robert H, Vachhrajani T, Sedor J, Gadegbeku C, Wang X. Renal Genetics Clinic: 3-Year Experience in the Cleveland Clinic. Kidney Med 2022; 5:100585. [PMID: 36712315 PMCID: PMC9874141 DOI: 10.1016/j.xkme.2022.100585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Rationale & Objective There has been an increasing demand for the expertise provided by a renal genetics clinic. Such programs are limited in the United States and typically operate in a genomics research setting. Here we report a 3-year, real-world, single-center renal genetics clinic experience. Study Design Retrospective cohort. Setting & Participants Outpatient cases referred to the renal genetics clinic of the Cleveland Clinic between January 2019 and March 2022 were reviewed. Analytical Approach Clinical and laboratory characteristics were analyzed. All genetic testing was performed in clinical labs. Results 309 new patients referred from 15 specialties were evaluated, including 118 males and 191 females aged 35.1 ± 20.3 years. Glomerular diseases were the leading presentation followed by cystic kidney diseases, electrolyte disorders, congenital anomalies of kidneys and urinary tract, nephrolithiasis, and tubulointerstitial kidney diseases. Dysmorphic features were noted in 27 (8.7%) patients. Genetic testing was recommended in 292 (94.5%) patients including chromosomal microarray (8.9%), single-gene tests (19.5%), multigene panels (77.3%), and exome sequencing (17.5%). 80.5% of patients received insurance coverage for genetic testing. 45% (115/256) of patients had positive results, 25% (64/256) had variants of unknown significance, and 22.3% (57/256) had negative results. 43 distinct monogenic disorders were diagnosed. Family history of kidney disease was present in 52.8% of patients and associated with positive genetic findings (OR, 2.28; 95% CI, 1.40-3.74). 69% of patients with positive results received a new diagnosis and/or a change in the diagnosis. Among these, 39.7% (31/78) of patients received a significant change in disease management. Limitations Retrospective and single-center study. Conclusions The renal genetics clinic plays important roles in the diagnosis and management of patients with genetic kidney diseases. Multigene panels are the most frequently used testing modality with a high diagnostic yield. Family history of kidney disease is a strong indication for renal genetics clinic referral.
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Affiliation(s)
- Xin Yee Tan
- Department of Kidney Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Chloe Borden
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio
| | - Mary-Beth Roberts
- Center for Personalized Genetic Healthcare, Cleveland Clinic, Cleveland, Ohio
| | - Sarah Mazzola
- Center for Personalized Genetic Healthcare, Cleveland Clinic, Cleveland, Ohio
| | - Queenie K.-G. Tan
- Center for Personalized Genetic Healthcare, Cleveland Clinic, Cleveland, Ohio
| | - Richard Fatica
- Department of Kidney Medicine, Cleveland Clinic, Cleveland, Ohio
| | - James Simon
- Department of Kidney Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Juan Calle
- Department of Kidney Medicine, Cleveland Clinic, Cleveland, Ohio
| | | | - Katherine Dell
- Center for Pediatric Nephrology and Hypertension, Cleveland Clinic Children’s, Cleveland, Ohio
| | | | - Diana Deitzer
- Department of Kidney Medicine, Cleveland Clinic, Cleveland, Ohio
| | | | - Ali Mehdi
- Department of Kidney Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Michael Lioudis
- Section of Nephrology, Upstate Medical University, Syracuse, New York
| | - Emilio D. Poggio
- Department of Kidney Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Georges Nakhoul
- Department of Kidney Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Saul Nurko
- Department of Kidney Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Tarek Ashour
- Department of Kidney Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Raed N. Bou Matar
- Center for Pediatric Nephrology and Hypertension, Cleveland Clinic Children’s, Cleveland, Ohio
| | - Charles Kwon
- Center for Pediatric Nephrology and Hypertension, Cleveland Clinic Children’s, Cleveland, Ohio
| | - Brian Stephany
- Department of Kidney Medicine, Cleveland Clinic, Cleveland, Ohio
| | - George Thomas
- Department of Kidney Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Yu-Wei Cheng
- Molecular Genetics, Cleveland Clinic, Cleveland, Ohio
| | - Deanna Leingang
- Center for Personalized Genetic Healthcare, Cleveland Clinic, Cleveland, Ohio
| | - Adnan Alsadah
- Center for Personalized Genetic Healthcare, Cleveland Clinic, Cleveland, Ohio
| | - Rhyan Maditz
- Department of Kidney Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Heyka Robert
- Department of Kidney Medicine, Cleveland Clinic, Cleveland, Ohio
| | | | - John Sedor
- Department of Kidney Medicine, Cleveland Clinic, Cleveland, Ohio
| | | | - Xiangling Wang
- Department of Kidney Medicine, Cleveland Clinic, Cleveland, Ohio,Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio,Center for Personalized Genetic Healthcare, Cleveland Clinic, Cleveland, Ohio,Genomic Medicine Institute, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio,Department of Molecular Medicine, Lerner College of Medicine, Case Western Reserve University, Cleveland, Ohio,Address for Correspondence: Xiangling Wang, MD, PhD, 9500 Euclid Ave, Cleveland, OH 44195
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Nadkarni GN, Fei K, Ramos MA, Hauser D, Bagiella E, Ellis SB, Sanderson S, Scott SA, Sabin T, Madden E, Cooper R, Pollak M, Calman N, Bottinger EP, Horowitz CR. Effects of Testing and Disclosing Ancestry-Specific Genetic Risk for Kidney Failure on Patients and Health Care Professionals: A Randomized Clinical Trial. JAMA Netw Open 2022; 5:e221048. [PMID: 35244702 PMCID: PMC8897752 DOI: 10.1001/jamanetworkopen.2022.1048] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
IMPORTANCE Risk variants in the apolipoprotein L1 (APOL1 [OMIM 603743]) gene on chromosome 22 are common in individuals of West African ancestry and confer increased risk of kidney failure for people with African ancestry and hypertension. Whether disclosing APOL1 genetic testing results to patients of African ancestry and their clinicians affects blood pressure, kidney disease screening, or patient behaviors is unknown. OBJECTIVE To determine the effects of testing and disclosing APOL1 genetic results to patients of African ancestry with hypertension and their clinicians. DESIGN, SETTING, AND PARTICIPANTS This pragmatic randomized clinical trial randomly assigned 2050 adults of African ancestry with hypertension and without existing chronic kidney disease in 2 US health care systems from November 1, 2014, through November 28, 2016; the final date of follow-up was January 16, 2018. Patients were randomly assigned to undergo immediate (intervention) or delayed (waiting list control group) APOL1 testing in a 7:1 ratio. Statistical analysis was performed from May 1, 2018, to July 31, 2020. INTERVENTIONS Patients randomly assigned to the intervention group received APOL1 genetic testing results from trained staff; their clinicians received results through clinical decision support in electronic health records. Waiting list control patients received the results after their 12-month follow-up visit. MAIN OUTCOMES AND MEASURES Coprimary outcomes were the change in 3-month systolic blood pressure and 12-month urine kidney disease screening comparing intervention patients with high-risk APOL1 genotypes and those with low-risk APOL1 genotypes. Secondary outcomes compared these outcomes between intervention group patients with high-risk APOL1 genotypes and controls. Exploratory analyses included psychobehavioral factors. RESULTS Among 2050 randomly assigned patients (1360 women [66%]; mean [SD] age, 53 [10] years), the baseline mean (SD) systolic blood pressure was significantly higher in patients with high-risk APOL1 genotypes vs those with low-risk APOL1 genotypes and controls (137 [21] vs 134 [19] vs 133 [19] mm Hg; P = .003 for high-risk vs low-risk APOL1 genotypes; P = .001 for high-risk APOL1 genotypes vs controls). At 3 months, the mean (SD) change in systolic blood pressure was significantly greater in patients with high-risk APOL1 genotypes vs those with low-risk APOL1 genotypes (6 [18] vs 3 [18] mm Hg; P = .004) and controls (6 [18] vs 3 [19] mm Hg; P = .01). At 12 months, there was a 12% increase in urine kidney disease testing among patients with high-risk APOL1 genotypes (from 39 of 234 [17%] to 68 of 234 [29%]) vs a 6% increase among those with low-risk APOL1 genotypes (from 278 of 1561 [18%] to 377 of 1561 [24%]; P = .10) and a 7% increase among controls (from 33 of 255 [13%] to 50 of 255 [20%]; P = .01). In response to testing, patients with high-risk APOL1 genotypes reported more changes in lifestyle (a subjective measure that included better dietary and exercise habits; 129 of 218 [59%] vs 547 of 1468 [37%]; P < .001) and increased blood pressure medication use (21 of 218 [10%] vs 68 of 1468 [5%]; P = .005) vs those with low-risk APOL1 genotypes; 1631 of 1686 (97%) declared they would get tested again. CONCLUSIONS AND RELEVANCE In this randomized clinical trial, disclosing APOL1 genetic testing results to patients of African ancestry with hypertension and their clinicians was associated with a greater reduction in systolic blood pressure, increased kidney disease screening, and positive self-reported behavior changes in those with high-risk genotypes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02234063.
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Affiliation(s)
- Girish N. Nadkarni
- Division of Nephrology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
- The Charles Bronfman Institute for Personalized Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Kezhen Fei
- Department of Population Health Sciences and Policy, Icahn School of Medicine at Mount Sinai, New York, New York
- Institute for Health Equity Research, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Michelle A. Ramos
- Department of Population Health Sciences and Policy, Icahn School of Medicine at Mount Sinai, New York, New York
- Institute for Health Equity Research, Icahn School of Medicine at Mount Sinai, New York, New York
| | | | - Emilia Bagiella
- Department of Population Health Sciences and Policy, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Stephen B. Ellis
- The Charles Bronfman Institute for Personalized Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Saskia Sanderson
- The Charles Bronfman Institute for Personalized Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Stuart A. Scott
- The Charles Bronfman Institute for Personalized Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, New York
- Sema4, A Mount Sinai Venture, Stamford, Connecticut
| | - Tatiana Sabin
- Department of Population Health Sciences and Policy, Icahn School of Medicine at Mount Sinai, New York, New York
- Institute for Health Equity Research, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Ebony Madden
- National Human Genome Research Institute, Bethesda, Maryland
| | - Richard Cooper
- Department of Public Health Sciences, Loyola University Medical School, Maywood, Illinois
| | - Martin Pollak
- Division of Nephrology, Harvard Medical School, Boston, Massachusetts
| | - Neil Calman
- Institute for Health Equity Research, Icahn School of Medicine at Mount Sinai, New York, New York
- Institute for Family Health, New York, New York
| | - Erwin P. Bottinger
- Division of Nephrology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
- The Charles Bronfman Institute for Personalized Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
- Digital Health Center, Hasso Plattner Institute, Potsdam, Germany
| | - Carol R. Horowitz
- The Charles Bronfman Institute for Personalized Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
- Department of Population Health Sciences and Policy, Icahn School of Medicine at Mount Sinai, New York, New York
- Institute for Health Equity Research, Icahn School of Medicine at Mount Sinai, New York, New York
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Mrug M, Bloom MS, Seto C, Malhotra M, Tabriziani H, Gauthier P, Sidlow V, McKanna T, Billings PR. Genetic Testing for Chronic Kidney Diseases: Clinical Utility and Barriers Perceived by Nephrologists. Kidney Med 2021; 3:1050-1056. [PMID: 34939014 PMCID: PMC8664736 DOI: 10.1016/j.xkme.2021.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
Rationale & Objective The identification of pathogenic variants in genes associated with chronic kidney disease can provide patients and nephrologists with actionable information to guide diagnoses and therapeutic plans. However, many nephrologists do not use genetic testing despite costs decreasing over time and more widespread availability. Study Design We conducted a survey to uncover the perceptions of general adult nephrologists about the utility of and barriers to genetic testing in clinical practice. Setting & Participants The online survey was administered to board-certified nephrologists (n = 10,054) in the United States. Analytical Approach We analyzed demographic characteristics of the survey respondents and their responses in the context of their use of genetic testing in routine clinical practice. Results A total of 149 nephrologists completed the survey, with 72% (107 of 149) reporting genetic test use in their practice. On average, tests were ordered for 3.8% of their patient population. Thirty-five percent of responses from nephrologists without a history of genetic test use ranked perceived barriers as "extremely significant" compared with 23% of responses from those who had previously used genetic tests. However, both users and nonusers of genetic tests indicated high cost (users: 46%, 49 of 107; nonusers 69%, 29 of 42) and poor availability or lack of ease (users: 33%, 35 of 107; nonusers: 57%; 24 of 42) of genetic testing as the most significant perceived barriers to implementation. Limitations The survey used in this study was not previously validated; additionally, because of the relatively small number of responses, there might have been a selection bias among the responders. Conclusions Although most nephrologists reported using genetic tests in clinical practice, high costs and poor availability or the lack of ease of use were perceived as the most important barriers to routine adoption. These observations indicate that educational programs that cover a range of topics, from genetics of chronic kidney disease to selection of the test, may help mitigate these barriers and enhance the use of genetic testing in nephrology practice.
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Affiliation(s)
- Michal Mrug
- Department of Medicine, The University of Alabama at Birmingham, Birmingham, Alabama.,Department of Veterans Affairs Medical Center, Birmingham, Alabama
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Rybicka-Kozlowska E, Andreoni K, Kozlowski T. Racial differences in renal transplantation: How do we bridge the gap? Surgery 2021; 170:333-335. [PMID: 33810852 DOI: 10.1016/j.surg.2021.02.030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 02/11/2021] [Accepted: 02/13/2021] [Indexed: 12/21/2022]
Affiliation(s)
| | - Kenneth Andreoni
- Department of Surgery, University of Florida College of Medicine, Gainesville, FL
| | - Tomasz Kozlowski
- Department of Surgery, The Oklahoma University College of Medicine, Oklahoma City, OK.
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Spiech KM, Tripathy PR, Woodcock AM, Sheth NA, Collins KS, Kannegolla K, Sinha AD, Sharfuddin AA, Pratt VM, Khalid M, Hains DS, Moe SM, Skaar TC, Moorthi RN, Eadon MT. Implementation of a Renal Precision Medicine Program: Clinician Attitudes and Acceptance. Life (Basel) 2020; 10:life10040032. [PMID: 32224869 PMCID: PMC7235993 DOI: 10.3390/life10040032] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 03/19/2020] [Accepted: 03/20/2020] [Indexed: 12/11/2022] Open
Abstract
A precision health initiative was implemented across a multi-hospital health system, wherein a panel of genetic variants was tested and utilized in the clinical care of chronic kidney disease (CKD) patients. Pharmacogenomic predictors of antihypertensive response and genomic predictors of CKD were provided to clinicians caring for nephrology patients. To assess clinician knowledge, attitudes, and willingness to act on genetic testing results, a Likert-scale survey was sent to and self-administered by these nephrology providers (N = 76). Most respondents agreed that utilizing pharmacogenomic-guided antihypertensive prescribing is valuable (4.0 ± 0.7 on a scale of 1 to 5, where 5 indicates strong agreement). However, the respondents also expressed reluctance to use genetic testing for CKD risk stratification due to a perceived lack of supporting evidence (3.2 ± 0.9). Exploratory sub-group analyses associated this reluctance with negative responses to both knowledge and attitude discipline questions, thus suggesting reduced exposure to and comfort with genetic information. Given the evolving nature of genomic implementation in clinical care, further education is warranted to help overcome these perception barriers.
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Affiliation(s)
- Katherine M. Spiech
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN 46202, USA; (K.M.S.); (P.R.T.); (A.M.W.); (N.A.S.); (K.S.C.); (K.K.); (A.D.S.); (A.A.S.); (S.M.M.); (T.C.S.); (R.N.M.)
| | - Purnima R. Tripathy
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN 46202, USA; (K.M.S.); (P.R.T.); (A.M.W.); (N.A.S.); (K.S.C.); (K.K.); (A.D.S.); (A.A.S.); (S.M.M.); (T.C.S.); (R.N.M.)
| | - Alex M. Woodcock
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN 46202, USA; (K.M.S.); (P.R.T.); (A.M.W.); (N.A.S.); (K.S.C.); (K.K.); (A.D.S.); (A.A.S.); (S.M.M.); (T.C.S.); (R.N.M.)
| | - Nehal A. Sheth
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN 46202, USA; (K.M.S.); (P.R.T.); (A.M.W.); (N.A.S.); (K.S.C.); (K.K.); (A.D.S.); (A.A.S.); (S.M.M.); (T.C.S.); (R.N.M.)
| | - Kimberly S. Collins
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN 46202, USA; (K.M.S.); (P.R.T.); (A.M.W.); (N.A.S.); (K.S.C.); (K.K.); (A.D.S.); (A.A.S.); (S.M.M.); (T.C.S.); (R.N.M.)
| | - Karthik Kannegolla
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN 46202, USA; (K.M.S.); (P.R.T.); (A.M.W.); (N.A.S.); (K.S.C.); (K.K.); (A.D.S.); (A.A.S.); (S.M.M.); (T.C.S.); (R.N.M.)
| | - Arjun D. Sinha
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN 46202, USA; (K.M.S.); (P.R.T.); (A.M.W.); (N.A.S.); (K.S.C.); (K.K.); (A.D.S.); (A.A.S.); (S.M.M.); (T.C.S.); (R.N.M.)
| | - Asif A. Sharfuddin
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN 46202, USA; (K.M.S.); (P.R.T.); (A.M.W.); (N.A.S.); (K.S.C.); (K.K.); (A.D.S.); (A.A.S.); (S.M.M.); (T.C.S.); (R.N.M.)
| | - Victoria M. Pratt
- Department of Medical and Molecular Genetics, Indiana University School of Medicine, Indianapolis, IN 46202, USA;
| | - Myda Khalid
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN 46202, USA; (M.K.); (D.S.H.)
| | - David S. Hains
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN 46202, USA; (M.K.); (D.S.H.)
| | - Sharon M. Moe
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN 46202, USA; (K.M.S.); (P.R.T.); (A.M.W.); (N.A.S.); (K.S.C.); (K.K.); (A.D.S.); (A.A.S.); (S.M.M.); (T.C.S.); (R.N.M.)
| | - Todd C. Skaar
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN 46202, USA; (K.M.S.); (P.R.T.); (A.M.W.); (N.A.S.); (K.S.C.); (K.K.); (A.D.S.); (A.A.S.); (S.M.M.); (T.C.S.); (R.N.M.)
| | - Ranjani N. Moorthi
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN 46202, USA; (K.M.S.); (P.R.T.); (A.M.W.); (N.A.S.); (K.S.C.); (K.K.); (A.D.S.); (A.A.S.); (S.M.M.); (T.C.S.); (R.N.M.)
| | - Michael T. Eadon
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN 46202, USA; (K.M.S.); (P.R.T.); (A.M.W.); (N.A.S.); (K.S.C.); (K.K.); (A.D.S.); (A.A.S.); (S.M.M.); (T.C.S.); (R.N.M.)
- Correspondence: ; Tel.: 317-274-2502; Fax: 317-274-8575
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Umeukeje EM, Young BA. Genetics and ESKD Disparities in African Americans. Am J Kidney Dis 2019; 74:811-821. [PMID: 31606237 PMCID: PMC7373097 DOI: 10.1053/j.ajkd.2019.06.006] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Accepted: 06/09/2019] [Indexed: 12/22/2022]
Abstract
African Americans have a 2- to 4-fold greater incidence of end-stage kidney disease (ESKD) than whites, which has long raised the possibility of a genetic cause for this disparity. Recent advances in genetic studies have shown a causal association of polymorphisms at the apolipoprotein L1 gene (APOL1) with the markedly increased risk for the nondiabetic component of the overall disparity in ESKD in African Americans. Although APOL1-associated kidney disease is thought to account for a substantial proportion of ESKD in African Americans, not all the increased risk for ESKD is accounted for, and a complete cataloging of disparities in genetic causes of ESKD eludes our current understanding of genetic-associated kidney disease. Genetic testing aids the screening, diagnosis, prognosis, and treatment of diseases with a genetic basis. Widespread use of genetic testing in clinical practice is limited by the small number of actionable genetic variants, limited health literacy of providers and patients, and underlying complex ethical, legal, and social issues. This perspective reviews racial and ethnic differences associated with genetic diseases and the development of ESKD in African Americans and discusses potential uncertainties associated with our current understanding of penetrance of genetically linked kidney disease and population-attributable risk percent.
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Affiliation(s)
- Ebele M Umeukeje
- Division of Nephrology, Vanderbilt University Medical Center, Nashville, TN; Vanderbilt Center for Kidney Disease, Nashville, TN
| | - Bessie A Young
- Nephrology, Hospital and Specialty Medicine and Center for Innovation for Veteran-Centered and Value Driven Care, Veterans Affairs Puget Sound Health Care System, Seattle, WA; Kidney Research Institute and Division of Nephrology, University of Washington, Seattle, WA.
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8
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Wiisanen Weitzel K. Pharmacists advancing role in pharmacogenomics. J Am Pharm Assoc (2003) 2018. [DOI: 10.1016/j.japh.2018.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Asleh R, Snipelisky D, Hathcock M, Kremers W, Liu D, Batzler A, Jenkins G, Kushwaha S, Pereira NL. Genomewide association study reveals novel genetic loci associated with change in renal function in heart transplant recipients. Clin Transplant 2018; 32:e13395. [PMID: 30160337 DOI: 10.1111/ctr.13395] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Revised: 08/13/2018] [Accepted: 08/23/2018] [Indexed: 01/01/2023]
Abstract
BACKGROUND Renal dysfunction occurs commonly after heart transplantation (HTx) with wide inter-individual variability but whether a genetic predisposition exists in these patients is unknown. Genomewide association studies (GWAS) have not been performed to assess the association of genetic variation with change in renal function after HTx. METHODS Clinical and demographic data of patients who underwent HTx and provided blood samples and consent for genetic analysis were included. Genotyping was performed using Illumina Infinium Human CoreExome v1.0 analysis kit. A GWAS utilizing linear regression models was performed with estimated glomerular filtration rate (eGFR) at 1 year as the phenotype after adjusting for baseline eGFR prior to HTx and conversion from calcineurin inhibitor to sirolimus as primary immunosuppression therapy. RESULTS A total of 251 HTx recipients were genotyped for 314,903 single nucleotide polymorphisms (SNPs). The mean (SD) age was 50 (12.5) years; most patients were of European origin (n = 243, 96.8%) and males (n = 179, 71.3%). After adjustment for potential confounders, two variants, rs17033285 (P = 4.3 × 10-7 ) and rs4917601 (P = 6.46 × 10-7 ), in a long non-coding RNA (lncRNA) gene LINC01121 and a pseudogene BTBD7P2, were identified to have a significant association with change in GFR at 1 year after HTx. CONCLUSIONS Our first of its kind GWAS demonstrates that genetic variation affects renal function after HTx independent of other risk factors. Agnostic genetic approaches such as these may lead to identification of novel biological pathways such as the role of lncRNAs in the development of renal dysfunction post-HTx.
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Affiliation(s)
- Rabea Asleh
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
| | - David Snipelisky
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Matthew Hathcock
- Department of Biomedical Statistic and Informatics, Mayo Clinic, Rochester, Minnesota
| | - Walter Kremers
- Department of Biomedical Statistic and Informatics, Mayo Clinic, Rochester, Minnesota
| | - Duan Liu
- Department of Molecular Pharmacology and Experimental Therapeutics, Mayo Clinic, Rochester, Minnesota
| | - Anthony Batzler
- Department of Biomedical Statistic and Informatics, Mayo Clinic, Rochester, Minnesota
| | - Gregory Jenkins
- Department of Biomedical Statistic and Informatics, Mayo Clinic, Rochester, Minnesota
| | - Sudhir Kushwaha
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
| | - Naveen L Pereira
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota.,Department of Molecular Pharmacology and Experimental Therapeutics, Mayo Clinic, Rochester, Minnesota
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Hindorff LA, Bonham VL, Brody LC, Ginoza MEC, Hutter CM, Manolio TA, Green ED. Prioritizing diversity in human genomics research. Nat Rev Genet 2018; 19:175-185. [PMID: 29151588 PMCID: PMC6532668 DOI: 10.1038/nrg.2017.89] [Citation(s) in RCA: 240] [Impact Index Per Article: 40.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Recent studies have highlighted the imperatives of including diverse and under-represented individuals in human genomics research and the striking gaps in attaining that inclusion. With its multidecade experience in supporting research and policy efforts in human genomics, the National Human Genome Research Institute is committed to establishing foundational approaches to study the role of genomic variation in health and disease that include diverse populations. Large-scale efforts to understand biology and health have yielded key scientific findings, lessons and recommendations on how to increase diversity in genomic research studies and the genomic research workforce. Increased attention to diversity will increase the accuracy, utility and acceptability of using genomic information for clinical care.
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Affiliation(s)
- Lucia A Hindorff
- National Human Genome Research Institute, National Institutes of Health, Bethesda, Maryland 20892-2152, USA
| | - Vence L Bonham
- National Human Genome Research Institute, National Institutes of Health, Bethesda, Maryland 20892-2152, USA
| | - Lawrence C Brody
- National Human Genome Research Institute, National Institutes of Health, Bethesda, Maryland 20892-2152, USA
| | - Margaret E C Ginoza
- National Human Genome Research Institute, National Institutes of Health, Bethesda, Maryland 20892-2152, USA
| | - Carolyn M Hutter
- National Human Genome Research Institute, National Institutes of Health, Bethesda, Maryland 20892-2152, USA
| | - Teri A Manolio
- National Human Genome Research Institute, National Institutes of Health, Bethesda, Maryland 20892-2152, USA
| | - Eric D Green
- National Human Genome Research Institute, National Institutes of Health, Bethesda, Maryland 20892-2152, USA
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