ABSTRACT

OBJECTIVES (1) To examine ‘race’ in acute and chronic kidney disease under similar conditions, and (2) to encourage further study of implied cofactors and an international approach to end misuse of ‘race’.

METHODS We re-analyzed data from United States veterans, (1) comparing outcomes after removing ‘race correction’ from legacy estimated glomerular filtration rates and (2) graphing data to explore more subtle relationships. We hypothesized factors confounding the link between kidney disease and apolipoprotein L1 gene variants, including cofactors implied and controlled by veteran status.

RESULTS Studies of veterans minimized ‘racial’ disparity in chronic kidney disease, suggesting an effect of starting conditions, including Armed Services entry requirements and equitable access to healthcare. Apolipoprotein L1 “high-risk” and N264K+ gene variants may be proxies for ‘race’, with gradients of effect due to colorism.

CONCLUSIONS Under equitable conditions, comparable kidney disease outcomes should be the expected norm for all, regardless of ‘race’, ethnicity, or nationality. Discouraging misuse of ‘race’ in medical research and healthcare is an actionable Population Health initiative with potentially high impact but low effort and cost.

Competing Interest Statement

The authors have declared no competing interest.

Funding Statement

This study did not receive any funding.

Author Declarations

I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.

Yes

The details of the IRB/oversight body that provided approval or exemption for the research described are given below:

The study used ONLY openly available human data that were originally published in the three source articles.

I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals.

Yes

I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance).

Yes

I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable.

Yes

Data Availability

All data re-analyzed in the present work are contained in the manuscript or are publicly available in the original source articles.

ABBREVIATIONSAKIacute kidney injuryAPOL1apolipoprotein L1BSbad scienceCKDchronic kidney diseaseCOVIDcoronavirus diseaseeGFRestimated GFRFSGSfocal segmental glomerulosclerosisGFRglomerular filtration rateHRhigh riskLRlow riskIRBinstitutional review boardKFkidney failureMDRDModification of Diet in Renal DiseaseNASEMNational Academies of Science Engineering and MedicineORodds ratioRRrelative riskRVrisk variantSDOHsocial determinants of healthVAVeterans Administration