Evaluation of Allostatic Load as a Mediator of Sleep and Kidney Outcomes in Black Americans.
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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.
Published Version (Please cite this version)10.1016/j.ekir.2018.12.005
Publication InfoScialla, Julia; Lunyera, Joseph; Bhavsar, Nrupen; Stanifer, John; Pendergast, Jane; Boulware, Ebony; ... Ricardo, Ana C (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.
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Assistant Professor in Medicine
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
Eleanor Easley Chair in the School of Medicine
Dr. Boulware is the Eleanor Easley Chair in the School of Medicine, Chief of the Division of General Internal Medicine in the Department of Medicine, Vice Dean for Translational Science, and Associate Vice Chancellor for Translational Research at Duke University. She is a general internist and clinical epidemiologist. She studies mechanisms to improve the quality and equity of health care and health outcomes for individuals and populations affected by chronic health conditions including kidne
Associate Professor of Medicine
I am an in-training physician-scientist with expertise in clinical epidemiology and health policy. My life-long desire is 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 socio-environmental exposures might increase risk for adverse kidney outcomes such as chronic kidney disease and acute kidney injury
Professor 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.
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
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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