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…

The National Institute of Diabetes and Digestive and Kidney Diseases awarded Boston Medical Center Corporation $918,576 on June 24, 2026, under the Diabetes, Digestive, and Kidney Diseases Extramural Research program (CFDA 93.847) to investigate the mechanistic link between sociodemographic stressors and chronic kidney disease and end-stage kidney disease incidence in Black women.

The research utilizes the Black Women's Health Study to model how cumulative allostatic load — chronic stress and measurable stress responses across nine objective biomarkers — accelerates renal decline. The study employs two measurable sociodemographic factors: the Area Deprivation Index, a composite measure of socioeconomic disadvantage within geographic areas, and the Income of Concentration at Extremes, a continuous measure of concentrated neighborhood affluence and poverty. The central hypothesis posits that chronic exposure to high area deprivation and low income concentration increase allostatic load through health-risk behaviors, leading to chronic kidney disease and kidney failure. The research addresses the notably higher incidence of chronic kidney disease in Black women compared to other patient populations and Black women's approximately 4-fold higher risk of end-stage kidney disease compared to white women.

The award supports three specific aims: determining associations of sociodemographic measures with incident chronic kidney disease and end-stage kidney disease using epidemiologic data and mediation analyses; examining associations of allostatic load with kidney disease and elucidating biological pathways; and identifying targeted intervention opportunities.

Performance occurs in Roxbury, Massachusetts, with a period of performance extending from June 24, 2026, through February 28, 2031.

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.