Dietary Patterns, Apolipoprotein L1 Risk Genotypes, and CKD Outcomes Among Black Adults in the Reasons for Geographic and Racial Differences in Stroke (REGARDS) Cohort Study

Rationale & Objective: Dietary factors may impact inflammation and interferon production, which could influence phenotypic expression of Apolipo-protein1 (APOL1) genotypes. We investigated whether associations of dietary patterns with kid-ney outcomes differed by APOL1 genotypes.Study Design: Prospective cohort.Settings & Participants: 5,640 Black participants in the Reasons for Geographic and Racial Differ-ences in Stroke (REGARDS).Exposures: Five dietary patterns derived from food frequency questionnaires: Convenience foods, Southern, Sweets and Fats, Plant-based, and Alcohol/Salads.Outcomes: Incident chronic kidney disease (CKD), CKD progression, and kidney failure. Inci-dent CKD was defined as a change in estimated glomerular filtration rate (eGFR) to <60 mL/min/ 1.73 m2 accompanied by a >= 25% decline from baseline eGFR or development of kidney failure among those with baseline eGFR >= 60 mL/1.73 m2 body surface area. CKD progression was defined as a composite of 40% reduction in eGFR from baseline or development of kidney failure in the subset of participants who had serum creatinine levels at baseline and completed a second in-home visit/follow-up visit. Analytical Approach: We examined associations of dietary pattern quartiles with incident CKD (n=4,18 8), CKD progression (n=5,64 0), and kidney failure (n=5,64 0). We tested for statistical interaction between dietary patterns and APOL1 genotypes for CKD outcomes and explored strati-fied analyses by APOL1 genotypes.Results: Among 5,640 Black REGARDS partici-pants, mean age was 64 years (standard deviation = 9), 35% were male, and 682 (12.1%) had high-risk APOL1 genotypes. Highest versus lowest quartiles (Q4 vs Q1) of Southern dietary pattern were associated with higher adjusted odds of CKD progression (OR, 1.28; 95% CI, 1.01-1.63) but not incident CKD (OR, 0.92; 95% CI, 0.74-1.14) or kidney failure (HR, 1.48; 95% CI, 0.90-2.4 4). No other dietary patterns showed significant associations with CKD. There were no statistically significant interactions between APOL1 genotypes and dietary patterns. Stratified analysis showed no consistent associations across genotypes, although Q3 and Q4 versus Q1 of Plant-based and Southern patterns were associated with lower odds of CKD progression among APOL1 high-but not low-risk genotypes. Limitations: Included overlapping dietary patterns based on a single time point and multiple testing.Conclusions: In Black REGARDS participants, Southern dietary pattern was associated with increased risk of CKD progression. Analyses stratified by APOL1 genotypes suggest associ-ations may differ by genetic background, but these findings require confirmation in other cohorts.