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Overview of The Human Heredity and Health in Africa Kidney Disease Research Network (H3A-KDRN).

Introduction The increasing prevalence of noncommunicable diseases in parallel with a high prevalence of communicable diseases threatens the lives of many in subSaharan Africa (SSA) and will overwhelm the already inadequate health budgets of African countries. CKD is common in SSA, with an estimated average prevalence of 14% (1). Patients with CKD are at increased risk of developing ESKD, cardiovascular disease, and death. The estimated prevalence of ESKD in SSA from diabetes and hypertension is 239 per million population, and of these only 2% of individuals who develop CKD stage 5 have access to maintenance dialysis or kidney transplantation (2). In a systematic review from Africa, 95% of adults and children with ESKD who could not access dialysis died or were presumed to have died, and 84% of adults with new-onset ESKD discontinued dialysis (3). The fourto five-fold increased risk of ESKD in Black people compared to European Americans is now attributed largely to variants in the Apolipoprotein L1 (APOL1) gene in the chromosome 22q12 locus, termed G1 and G2 (4,5). Recent studies show that the APOL1 gene variants are also associated with CKD in Africans (6). The APOL1 gene encodes circulating APOL1, which functions as a trypanolytic factor (4). The APOL1 renal risk variants evolved some 10,000 years ago in SSA, where trypanosomiasis was endemic, and have risen to a high prevalence in the population because they provided protection against Trypanosoma brucei rhodesiense (4). These variants are associated with an increased risk of hypertensionattributed ESKD, FSGS, HIV-associated nephropathy, and other nondiabetic kidney diseases (7). Given that ESKD afflicts an estimated 239,000 (per million population) individuals in SSA annually, there is a compelling need for identification of early modifiable risk markers of CKD, and a thorough investigation of the genetics of kidney disease causation and progression in African populations to promote the identification of new therapeutic targets and the formulation of effective treatment and prevention strategies.