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

Joseph Lunyera, Clemontina A. Davenport, Chandra L. Jackson, Dayna A. Johnson, Nrupen A. Bhavsar, Mario Sims, Julia J. Scialla, John W. Stanifer, Jane Pendergast, Ciaran J. McMullan, Ana C. Ricardo, Leigh Boulware, Clarissa Diamantidis

Research output: Contribution to journalArticle

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 m 2 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 m 2 (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.

Original languageEnglish (US)
Pages (from-to)425-433
Number of pages9
JournalKidney International Reports
Volume4
Issue number3
DOIs
Publication statusPublished - Mar 1 2019
Externally publishedYes

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Keywords

  • African Americans
  • kidney diseases
  • sleep
  • sleep deprivation

ASJC Scopus subject areas

  • Nephrology

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