Evaluation of Allostatic Load as a Mediator of Sleep and Kidney Outcomes in Black Americans.


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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Publication Info

Lunyera, Joseph, Clemontina A Davenport, Chandra L Jackson, Dayna A Johnson, Nrupen A Bhavsar, Mario Sims, Julia J Scialla, John W Stanifer, et al. (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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Tina Davenport

Biostatistician, Senior

Clemontina A. Davenport earned a MSTAT and PhD in Statistics at NC State University. 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.


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 disease research at the intersection of informatics, biostatistics, and epidemiology. My ongoing work aims to integrate informatics, epidemiology, and biostatistics to reduce the burden of chronic disease. I have topical expertise in multiple chronic diseases, including oncology, cardiovascular disease, and chronic kidney disease. In parallel, I have a portfolio of research that aims to understand the impact of social determinants of health, including dynamic neighborhood changes, such as gentrification, on the health of adults and children. 


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 nutrition. Current studies are focused on treatment and prevention of abnormal phosphate homeostasis, acid-base physiology, diabetic and other forms of kidney disease, and outcomes in end-stage kidney disease. 

Dr. Scialla’s work engages a number of study designs including prospective cohort studies, observational comparative effectiveness studies, and patient-oriented physiologic studies. She has worked closely with multiple chronic disease cohorts including the Chronic Renal Insufficiency Cohort (CRIC) Study, the African American Study of Kidney Disease and Hypertension (AASK), the Jackson Heart Study (JHS), and secondary analyses in clinical trials. Studies in electronic health records (EHR) and registries have engaged dialysis EHR data, the United States Renal Data System, and public registries, such as the National Health and Nutrition Examination Survey. Physiologic studies include the Acid Base Complication in CKD Study, secondary analyses in the DASH Mechanism Study, and the newly launched MURDOCK Kidney Health Study.


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.


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, shaped guidelines, raised physician awareness and changed clinical practice.  Throughout her work, Dr. Boulware has sought to improve transparency and trustworthiness in science and medicine. 

Her research has been continuously funded by the National Institutes for Health, the Patient Centered Outcomes Research Institute, and other organizations throughout her career. She has published over 200 manuscripts, book chapters, and editorials, and she mentors numerous students, residents, fellows, and faculty members.  Dr. Boulware is an elected member of the American Society for Clinical Investigation, the Association of American Physicians, the National Academy of Medicine, and the American Academy of Arts and Sciences.

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  • A.B. Vassar College, 1991
  • M.D. Duke University, 1995
  • M.P.H. Johns Hopkins Bloomberg School of Public Health, 1999


Clarissa Jonas Diamantidis

Adjunct Associate Professor of Medicine

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