African Americans have a markedly higher incidence of ESRD compared with other racial groups. Two variants in the APOL1 gene, to date observed only among individuals of recent African ancestry, associate with increased risk for renal disease among African Americans. Here, we investigated whether these risk alleles also associate with age at initiation of chronic hemodialysis. We performed a crosssectional study of 407 nondiabetic African Americans with ESRD who participated in the Accelerated Mortality on Renal Replacement (ArMORR) study, a prospective cohort of incident chronic hemodialysis patients. African Americans carrying two copies of the G1 risk allele initiated chronic hemodialysis at a mean age of 49.0 Ϯ 14.9 years, which was significantly younger than both subjects with one copy of the G1 allele (55.9 Ϯ 16.7 years; P ϭ 0.014) and subjects without either risk allele (61.8 Ϯ 17.1 years; P ϭ 6.2 ϫ 10 Ϫ7 ). The association between the presence of the G1 allele and age at initiation of hemodialysis remained statistically significant after adjusting for sociodemographic and other potential confounders. We did not detect an association between the G2 risk allele and age at initiation of hemodialysis, but the sample size was limited. In conclusion, genetic variations in APOL1 identify African Americans that initiate chronic hemodialysis at a younger age. Early interventions to prevent progression of kidney disease may benefit this high-risk population.

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Use of a 30-gauge, 5/16-inch insulin syringe instead of a 26-gauge, 3/8-inch tuberculin syringe does not significantly reduce either hematoma size or pain of injection. A larger study is required to determine whether needle size affects the frequency of hematoma formation.

Amiodarone-induced pulmonary toxicity (AIPT) is one of the most serious adverse effects of amiodarone therapy and can be fatal. Therefore, vigilant monitoring is advised. Baseline chest radiograph and pulmonary function tests and follow-up chest films at 3-month intervals are advocated. However, since abnormalities on these two examinations do not always precede symptoms, patient self-reports of respiratory symptoms appear to be the best method for early detection of AIPT.