# suPAR and APOL1-CKD in Sub-Saharan Africa

> **NIH NIH R01** · RUSH UNIVERSITY MEDICAL CENTER · 2020 · $192,499

## Abstract

African Americans (AA) are on average 4 times more likely to suffer from chronic kidney disease
(CKD) than European Americans. Recent studies have identified that APOL1 genetic risk
variants are associated with higher risker for developing progressive CKD, and especially
among those infected with HIV. The risk is up to 89 fold higher for those HIV individuals carrying
with two APOL1 risk alleles compared to low risk carriers. However, the majority of African
Americans who carry APOL1 risk alleles do not develop CKD, suggesting additional factors are
required for CKD development. Soluble urokinase receptor (suPAR) has also been identified as
risk factor for CKD including patients with HIV. Novel studies show that APOL1 and suPAR
biochemically interact and clinically, AA patients with both risk factors show the steepest yearly
eGFR decline. This translational proposal seeks to investigate the risk of combined impact of
genetic (APOL1) and environmental (suPAR) factors for development and progression of CKD.
The proposal analyzes APOL1 risk in the setting of HIV infection, which is associated with high
levels of suPAR that may be attenuated in those treated anti-retroviral therapy. We propose an
innovative study including HIV infected individuals from a well-established clinic sub-Saharan-
Africa (SSA) with high prevalence of APOL1 risk alleles to unravel insights into the unique
relationship of suPAR and APOL1. This proposal provides a large population to understand
gene-environment risk with adequate power, in a clinic with standardized clinical protocols and
free access to health care and medications, and lastly a complimentary H3 Africa Kidney
Network to validate findings. With these unique study attributes, we hypothesize that suPAR
and APOL1 gene mutation alone or in combination are driving forces in the development and
progression of CKD in HIV. Thus, in this proposed research program, we will conduct the
following: Aim 1, Determine the demographic, clinical and biochemical factors associated with
suPAR levels in 1000 HIV individuals before and after ART; Aim 2, Evaluate the association of
suPAR level and APOL 1 mutation with CKD prevalence and proteinuria among 5,000 HIV; and
Aim 3, Determine the longitudinal association of APOL1 risk and repeated suPAR levels with
incidence and progression of among study of 3000 HIV individuals on ART. We will also validate
the findings in the H3 Africa HIV-CKD cohort. In sum, this research program provides important
information on the factors contributing to elevated suPAR levels, the association with CKD and
also longitudinal association with repeated measures. These novel findings will be the basis for
preventive and treatment strategies to combat APOL1-CKD.

## Key facts

- **NIH application ID:** 9995017
- **Project number:** 5R01DK113761-03
- **Recipient organization:** RUSH UNIVERSITY MEDICAL CENTER
- **Principal Investigator:** Rulan S Parekh
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2020
- **Award amount:** $192,499
- **Award type:** 5
- **Project period:** 2018-09-15 → 2021-08-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/9995017

## Citation

> US National Institutes of Health, RePORTER application 9995017, suPAR and APOL1-CKD in Sub-Saharan Africa (5R01DK113761-03). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/9995017. Licensed CC0.

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