Ventral hippocampal-postcentral gyrus functional connectivity mediates the association of APOE ε4 gene dose, depressive symptoms, and cognitive function in mild cognitive impairment with subsyndromal

The frequency of chronic kidney disease (CKD) in Black individuals is two to three times higher than in White Americans. A portion of this increased risk appears attributable to polymorphisms in the gene encoding apolipoprotein L1 () (, ). The two renal risk variants (RRVs), G1 (two amino acid substitutions) and G2 (two amino acid deletions), evolved to confer resistance to certain subspecies of parasites. Combinations of two RRVs (G1/G1, G2/G2, or G1/G2) are referred to as high-risk genotypes and are associated with increased risk of CKD development and progression (). Many individuals with -associated kidney disease and subnephrotic proteinuria are misclassified as having CKD of unknown etiology or hypertension-attributed CKD (). In the United States, the estimated allelic frequency among Black Americans is 20%-22% for G1 and 13%-15% for G2, with approximately 10%-15% carrying an high-risk genotype (). Despite its clinical relevance for characterizing CKD etiology and risk, genetic testing remains uncommon among Black patients with established CKD or at risk for kidney complications. Patients with or at risk for CKD may experience concern related to uncertainty about their health and potential long-term complications, including the need for kidney replacement therapy (, ). In patients with or at risk for CKD, genetic diagnosis may offer several benefits, including greater understanding of disease etiology, improved genetic counseling for family planning, assessment of recurrence risk after kidney transplantation, and opportunities for presymptomatic testing among at-risk family members (). Conversely, a genetic diagnosis may have emotional consequences, including concern about future health risks and the possibility of transmitting genetic risk to offspring (, ). Even among healthy individuals, such as living kidney donor candidates, testing may evoke psychological distress and fear of kidney failure (). Disease-specific education can mitigate anxiety and improve engagement, as knowledge may foster adaptive illness perceptions and reduce misinformation (). In addition, testing and disclosure of genotype results have been associated with positive self-reported behavior changes and improved medication adherence among individuals with high-risk genotypes (). Despite growing recognition of the genetic and psychosocial dimensions of -associated kidney disease, data on how Black patients perceive and respond to genetic testing remain limited. Pilot studies suggest overall openness to genetic testing (), yet the nature and evolution of patient-reported concern and worry related to testing have not been well characterized. Understanding these responses is important for addressing potential psychological barriers and supporting informed engagement with precision nephrology. Therefore, we investigated patterns of concern about kidney conditions and worry related to high-risk genotypes among Black adults undergoing genotyping in a prospective cohort study, with the goal of better understanding how genetic risk information may influence perceptions relevant to kidney health and engagement in care.