Re-analyzed APOL1 kidney data support new ethics of ‘race’

The dominant paradigm in nephrology research attributes disparities in kidney disease outcomes, particularly between Black and White patients, to genetic factors, notably variants of the APOL1 gene. This paradigm frames 'race' as a biologically meaningful category with direct causal links to health outcomes.

This preprint challenges the prevailing paradigm by re-analyzing existing data on kidney disease in US veterans, a population group with more comparable social determinants of health than civilian cohorts. The authors remove the 'race correction' applied to estimated glomerular filtration rate (eGFR) calculations and demonstrate that this correction creates an artificial disparity in kidney failure risk between Black and White veterans. Further analysis of the APOL1 gene's impact on acute kidney injury (AKI) in veterans hospitalized with COVID-19, alongside comparison with a Brazilian study where 'race' is defined differently, suggests that social cofactors and the severity of illness may be more significant drivers of outcomes than APOL1 genotype. This research points towards a model drift, where existing data is reinterpreted to challenge the dominant paradigm's emphasis on genetic determinism. While not proposing a radical paradigm shift, the preprint argues for a greater focus on social determinants of health and the de-emphasis of 'race' as a biological factor in kidney disease research and clinical practice. The uncertainty lies in the degree of change advocated: it could be interpreted as late-stage normal science attempting to refine the current model by incorporating social factors, or as a more substantial move towards a new understanding of 'race' and health, hence the model drift classification.