Chronic kidney disease (CKD) is most commonly associated with diabetes (40%) and hypertension (28%), and affects 26 million American adults. African ancestry populations with hypertension (HTN) have 2- to 3-fold higher risk of developing CKD, and a 5-fold increased risk to progress to end stage renal disease (ESRD) when compared with whites. HTN is a risk factor for progression of CKD and for increased cardiovascular risk with CKD. Thus targeting blood pressure control as a modifiable risk factor may both reduce CVD in people with CKD and reduce progression of CKD to end stage disease. Recent discoveries demonstrate that testable alleles of the APOL1 locus on chromosome 22 have a major effect on and explain almost all of the excess risk for hypertension-associated CKD and its progression to ESRD in African ancestry populations.
We will use community-engaged approaches to enroll patients of African Ancestry with HTN from a network of community health centers and primary care facilities in Harlem and the Bronx and randomize them on a 7 to 1 ratio to receive APOL1 genetic testing and EMR-enabled provider clinical decision support incorporating APOL1 genomic risk information.
The research team is comprised of a multidisciplinary, multi-institutional, multicultural group of investigators that have conducted collaborative, translational research in genomics, CKD, hypertension, health disparities research, and have expertise in study trial design, recruitment, retention, implementation and analysis. Together, with our partners at the Institute for Family Health and the Centers for Community-Academic Research Partnerships (CCARP), our goal is to create new insights on how genomic medicine approaches will be adopted and whether they can make a difference to improve primary care for hypertensive kidney disease in populations of African ancestry.
Co-Principal Investigators: Carol Horowitz, MD, MPH, Site PI: Neil Calman, MD