Evaluation of Allostatic Load as a Mediator of Sleep and Kidney Outcomes in Black Americans.
Abstract
Introduction:Poor sleep associates with adverse chronic kidney disease (CKD) outcomes
yet the biological mechanisms underlying this relation remain unclear. One proposed
mechanism is via allostatic load, a cumulative biologic measure of stress. Methods:Using
data from 5177 Jackson Heart Study participants with sleep measures available, we
examined the association of self-reported sleep duration: very short, short, recommended,
and long (≤5, 6, 7-8, or ≥9 hours per 24 hours, respectively) and sleep quality (high,
moderate, low) with prevalent baseline CKD, and estimated glomerular filtration rate
(eGFR) decline and incident CKD at follow-up. CKD was defined as eGFR <60 ml/min per
1.73 m2 or urine albumin-to-creatinine ratio ≥30 mg/g. Models were adjusted for demographics,
comorbidities, and kidney function. We further evaluated allostatic load (quantified
at baseline using 11 biomarkers from neuroendocrine, metabolic, autonomic, and immune
domains) as a mediator of these relations using a process analysis approach. Results:Participants
with very short sleep duration (vs. 7-8 hours) had greater odds of prevalent CKD (odds
ratio [OR] 1.31, 95% confidence interval [CI] 1.03-1.66). Very short, short, or long
sleep duration (vs. 7-8 hours) was not associated with kidney outcomes over a median
follow-up of 8 years. Low sleep quality (vs. high) associated with greater odds of
prevalent CKD (OR 1.26, 95% CI 1.00-1.60) and 0.18 ml/min per 1.73 m2 (95% CI 0.00-0.36)
faster eGFR decline per year. Allostatic load did not mediate the associations of
sleep duration or sleep quality with kidney outcomes. Conclusions:Very short sleep
duration and low sleep quality were associated with adverse kidney outcomes in this
all-black cohort, but allostatic load did not appear to mediate these associations.
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https://hdl.handle.net/10161/18544Published Version (Please cite this version)
10.1016/j.ekir.2018.12.005Publication Info
Lunyera, Joseph; Davenport, Clemontina A; Jackson, Chandra L; Johnson, Dayna A; Bhavsar,
Nrupen A; Sims, Mario; ... Diamantidis, Clarissa J (2019). Evaluation of Allostatic Load as a Mediator of Sleep and Kidney Outcomes in Black
Americans. Kidney international reports, 4(3). pp. 425-433. 10.1016/j.ekir.2018.12.005. Retrieved from https://hdl.handle.net/10161/18544.This is constructed from limited available data and may be imprecise. To cite this
article, please review & use the official citation provided by the journal.
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Show full item recordScholars@Duke
Nrupen Bhavsar
Associate Professor in Surgery
I am a quantitative epidemiologist with methodological expertise in the design and
analysis of observational studies that leverage data from cohort studies, registries,
and the electronic health record (EHR). My background, training, and research is in
the measurement and characterization of biomarkers, risk factors and treatment outcomes
for chronic disease using real-world datasets. My primary research interests are in
the use of novel sources of data, including the EHR, to conduct chronic
L. Ebony Boulware
Adjunct Professor in the Department of Medicine
Dr. Boulware is a general internist, physician-scientist and clinical epidemiologist
focused on improving health and health equity for individuals and communities affected
by chronic health conditions such as kidney disease. A national thought leader in
health equity, she has identified patient, clinician, system, and community-level
barriers that result in disparate outcomes for Black and other marginalized individuals.
Using pragmatic trials, she has developed successful interventions, shap
Tina Davenport
Biostatistician, Senior
Dr. Davenport has extensive collaborative research experience investigating factors
that may explain racial disparities in health outcomes, primarily in kidney disease,
but also in diabetes, hypertension cardiovascular disease, and other areas. She teaches
a first-year masters level class and is passionate about teaching, mentorship, and
the importance of diversity and equity in research and healthcare.
Clarissa Jonas Diamantidis
Associate Professor of Medicine
Joseph Lunyera
Medical Instructor in the Department of Medicine
I am a clinical epidemiologist with a life-long desire to advance our understanding
of etiologic mechanisms of kidney disease, and to advocate for policies that promote
the highest quality care for individuals with kidney disease. Specifically, I am interested
in delineating mechanisms by which exposures in the social environment perpetuate
disparate adverse kidney outcomes such as chronic kidney disease and acute kidney
injury.
Jane Frances Pendergast
Professor Emeritus of Biostatistics & Bioinformatics
Dr. Pendergast is a senior faculty member in the Department of Biostatistics & Bioinformatics,
with specialized expertise in multivariate and longitudinal data. Before coming to
Duke, she was a Statistics/Biostatistics faculty member at the Universities of Florida
and Iowa. Her primary collaborations at Duke are with members of the Division of
General Internal Medicine and the Aging Center.
Julia Jarrard Scialla
Adjunct Associate Professor in the Department of Medicine
Dr. Scialla is an Associate Professor of Medicine in Nephrology at Duke University
and a faculty member at the Duke Clinical Research Institute. Dr. Scialla trained
in Internal Medicine, Nephrology, and Clinical Epidemiology at the Johns Hopkins University
School of Medicine and the Johns Hopkins Bloomberg School of Public Health. Her research
focuses on chronic kidney disease (CKD) epidemiology and prevention, with an emphasis
on the role of metabolic complications and nutri
John W. Stanifer
Adjunct Assistant Professor of Medicine
John W. Stanifer, MD, MSc-GH, is a nephrologist and clinical researcher with a focus
on using translational and trans-disciplinary methods to uncover mechanisms of global health
disparities in kidney disease. John completed his residency training in internal medicine
and global health at Duke, completing the Master of Science in Global Health program
in 2014. He also completed his sub-specialty training in nephrology at Duke, and during
that time, he also completed a fellowship in c
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