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The Impact of Allostatic Load on Kidney Disease

Award Number: R01DK142896
ORGANIZATION: NATIONAL INSTITUTE OF DIABETES & DIGESTIVE & KIDNEY DISEASES
OPDIV: NIH
AWARD CLASS: DISCRETIONARY
AWARD ACTIVITY TYPE: SCIENTIFIC/HEALTH RESEARCH (INCLUDES SURVEYS)
PERIOD OF PERFORMANCE START DATE: 06/24/2026
PERIOD OF PERFORMANCE END DATE: 02/28/2031

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The Impact of Allostatic Load on Kidney Disease - Modified Project Summary/Abstract Section This study investigates the mechanistic link between high-resolution sociodemographic stressors and incidence of chronic kidney disease (CKD) and end-stage kidney disease (ESKD) utilizing the Black Women’s Health Study (BWHS) to model how cumulative allostatic load accelerates renal decline. CKD is notably higher in Black women than other patient populations. Black women have ~4 fold the risk of ESKD compared to White women. Utilizing measurable adverse sociodemographic factors; 1) area deprivation index (ADI), a composite measure capturing socioeconomic disadvantage within geographic areas; and 2) the income of concentration at extremes (ICE), a continuous measure of concentrated neighborhood affluence and poverty, we will determine associations with CKD/ESKD. ADI and ICE increase the cumulative burden of allostatic load defined as chronic stress and stress responses measurable by 9 objective biomarkers, resulting in adverse health outcomes. The objective of this application is to investigate the impact of allostatic load on CKD and pathways connecting sociodemographic factors and incident CKD and ESKD. The central hypothesis posits that chronic exposure to high ADI and low ICE increase allostatic load via health-risk behaviors leading to the development of CKD and kidney failure. The rationale for this project is that elucidating biological pathways and mechanisms underlying social factors and kidney disease will advance how we identify and model CKD risk, enabling more effective targeted interventions in CKD in Black women. The hypothesis uses 3 specific aims: 1) Determine associations of ADI and ICE (using census data) with incident CKD and ESKD using epidemiologic data from BWHS and utilizing mediation analyses to identify effects of health-related behaviors and CKD risk factors on the associations; 2) Examine associations of allostatic load with kidney disease and elucidate underlying mechanisms. We will measure allostatic load using existing and new measurements of biomarkers in BWHS. We will replicate results in the REasons for Geographic and Racial Differences in Stroke (REGARDS) cohort to expand beyond a single-demographic and determine generalizability of allostatic load pathways in Black women extending to all populations; and 3) Elucidate how women with CKD perceive the impact of adverse social factors and social support on CKD. The Photovoice method will be used to identify measurable environmental exposures and coping mechanisms that contribute to the allostatic state, providing a granular, participant-level validation of the ADI/ICE metrics. This project is innovative in its focus on an understudied, high-risk population, and its integration of quantitative, qualitative, and biomarker approaches to elucidate how allostatic load drives CKD. This research is significant because it moves beyond characterization to identifying modifiable biological and social pathways that can be targeted for intervention. The expected outcomes will inform the development of actionable, mechanism-based strategies for early detection, prevention, and slowing of CKD progression.


Issue Date FY	Funding FY	Legal Entity Name	Legal Entity Address	Legal Entity City	Legal Entity State	Legal Entity Zip Code	Legal Entity COUNTY	Legal Entity COUNTRY	Assistance Listing	Award Code	Budget Year	Action Date	Action Type	Action Amount

Issue Date FY: 2026 ( Subtotal = $918,576 )
2026	2026	BOSTON MEDICAL CENTER CORPORATION	1 BOSTON MEDICAL CTR PL	BOSTON	MA	02118	SUFFOLK	USA	Diabetes, Digestive, and Kidney Diseases Extramural Research	000	1	7/7/2026	NEW	$918,576
														Subtotal = $918,576

Grand Total All Awards = $918,576

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The Impact of Allostatic Load on Kidney Disease

Award Number: R01DK142896

ORGANIZATION: NATIONAL INSTITUTE OF DIABETES & DIGESTIVE & KIDNEY DISEASES

OPDIV: NIH

AWARD CLASS: DISCRETIONARY

AWARD ACTIVITY TYPE: SCIENTIFIC/HEALTH RESEARCH (INCLUDES SURVEYS)

PERIOD OF PERFORMANCE START DATE: 06/24/2026

PERIOD OF PERFORMANCE END DATE: 02/28/2031

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