• Jamie R Privratsky, Yi-Ju Li, Carol Haynes, Mihai Podgoreanu, Joseph Mathew, Svati H Shah, and Mark Stafford-Smith.
• Department of Anesthesiology, Duke University Medical Center, Durham, NC. Electronic address: jamie.privratsky@duke.edu.
• J. Cardiothorac. Vasc. Anesth. 2020 Dec 1; 34 (12): 331433203314-3320.

ObjectiveAcute kidney injury (AKI) is a complication of cardiac surgery that is considerably more common in African Americans (1.5-fold). Although homozygous status for apolipoprotein L1 (APOL1) risk alleles is associated with chronic kidney disease in individuals of African ancestry, whether these coding variants confer AKI risk is unknown. The present study examined whether APOL1 homozygous risk allele status was associated with AKI in African Americans after cardiac surgery.DesignRetrospective analysis of a cohort.SettingSingle-center university hospital.ParticipantsAfrican American patients from the CATHeterization GENetics study cohort who underwent cardiac surgery with cardiopulmonary bypass.InterventionsGenotyping of APOL1 alleles.Measurements And Main ResultsData from 125 African American patients included 12 APOL1 risk (ie, homozygous for risk alleles) patients and 113 APOL1 control (ie, wildtype or heterozygous for risk alleles) patients. The primary outcome to reflect AKI was peak serum creatinine rise after surgery relative to the preoperative creatinine (%ΔCr). The secondary outcome was Kidney Disease: Improving Global Outcomes (KDIGO) AKI criteria. In the primary analysis, peak creatinine rise was higher in risk compared with control patients in both univariate (%ΔCr 69.1 v 29.6%; p = 0.005) and multivariate regression (%ΔCr 88.5 v 43.7%; p = 0.006) analyses. For the secondary outcome, a trend toward KDIGO AKI development was noted in APOL1 risk patients, but this was not statistically significant.ConclusionsAfrican American cardiac surgery patients homozygous for APOL1 chronic kidney disease risk variants averaged a more than 2-fold higher postoperative creatinine rise even after adjustment for other risk factors, suggesting these alleles also are independent risk factors for AKI.Copyright © 2020 Elsevier Inc. All rights reserved.

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