{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,5]],"date-time":"2026-11-05T17:47:18Z","timestamp":1793900838162,"version":"4.8.0"},"reference-count":51,"publisher":"BMJ","issue":"1","license":[{"start":{"date-parts":[[2021,1,18]],"date-time":"2021-01-18T00:00:00Z","timestamp":1610928000000},"content-version":"unspecified","delay-in-days":17,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/100006108","name":"National Center for Advancing Translational Sciences","doi-asserted-by":"publisher","award":["KL2 1UL1TR001445"],"award-info":[{"award-number":["KL2 1UL1TR001445"]}],"id":[{"id":"10.13039\/100006108","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100006351","name":"Colton Foundation","doi-asserted-by":"publisher","award":["Scholar Award"],"award-info":[{"award-number":["Scholar Award"]}],"id":[{"id":"10.13039\/501100006351","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100006260","name":"Rheumatology Research Foundation","doi-asserted-by":"publisher","award":["Scientist Development Award"],"award-info":[{"award-number":["Scientist Development Award"]}],"id":[{"id":"10.13039\/100006260","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Lupus Sci Med"],"accepted":{"date-parts":[[2020,12,23]]},"published-print":{"date-parts":[[2021,1]]},"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>\n                      Two apolipoprotein L1 (\n                      <jats:italic>APOL1<\/jats:italic>\n                      ) risk variants (RV) are enriched in sub-Saharan African populations due to conferred resistance to\n                      <jats:italic>Trypanosoma brucei<\/jats:italic>\n                      . These variants associate with adverse renal outcomes by multiple causes including SLE. Despite emerging reports that SLE is common in Ghana, where\n                      <jats:italic>APOL1<\/jats:italic>\n                      variant allelic frequencies are high, the regional contribution to SLE outcomes has not been described. Accordingly, this prospective longitudinal cohort study tested the associations between\n                      <jats:italic>APOL1<\/jats:italic>\n                      high-risk genotypes and kidney outcomes, organ damage accrual and death in 100 Ghanaian patients with SLE.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This was a prospective cohort study of 100 SLE outpatients who sought care at Korle bu Teaching Hospital in Accra, Ghana. Adult patients who met 4 American College of Rheumatology criteria for SLE were genotyped for APOL1 and followed longitudinally for SLE activity as measured by the Safety of Estrogens in Lupus National Assessment-Systemic Lupus Erythematosus Disease Activity Index (SELENA-SLEDAI) hybrid and organ injury as measured by the Systemic Lupus International Collaborating Clinics Damage Index (SDI) at baseline and every 6 months for 1 year. Outcomes of interest were kidney function, SDI and case fatality.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Assuming a recessive inheritance, the\n                      <jats:italic>APOL1<\/jats:italic>\n                      high-risk genotype (2RV) associated with end-stage renal disease (ESRD) at an OR of 14 (p=0.008). These patients accrued more SDI points particularly in renal and neurological domains. The SDI was 81.3% higher in 2RV patients compared with 0RV or 1RV patients despite no difference in SLE activity (p=0.01). After a 12-month period of observation, 3\/12 (25%) of the 2RV patients died compared with 2\/88 (2.3%) of the 0RV or 1RV carriers (OR=13.6, p=0.01). Deaths were due to end-stage kidney disease and heart failure.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>\n                      <jats:italic>APOL1<\/jats:italic>\n                      RVs were heritable risk factors for morbidity and mortality in this Ghanaian SLE cohort. Despite no appreciable differences in SLE activity,\n                      <jats:italic>APOL1<\/jats:italic>\n                      high-risk patients exhibited progressive renal disease, organ damage accrual and a 13-fold higher case fatality.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/lupus-2020-000460","type":"journal-article","created":{"date-parts":[[2021,1,18]],"date-time":"2021-01-18T11:45:37Z","timestamp":1610970337000},"page":"e000460","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":33,"title":["Apolipoprotein L1 risk genotypes in Ghanaian patients with systemic lupus erythematosus: a prospective cohort study"],"prefix":"10.1136","volume":"8","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0386-5259","authenticated-orcid":false,"given":"Ashira","family":"Blazer","sequence":"first","affiliation":[{"name":"Department of Medicine, Division of Rheumatology, NYU Langone Health, New 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