Chronic kidney disease (CKD) is a global public health problem. African Americans have a higher prevalence of late stage CKD than Whites and progress from early stage to late stage at a much more rapid rate. Biomedical explanations for African Americans' faster CKD progression prevail, with virtually no research attention paid to the role of social factors. Stress related to discrimination is a particularly compelling area of study in light of strong evidence demonstrating its linkages to CKD risk factors such as hypertension, diabetes, and obesity. The proposed proof of concept study will recruit 100 African American patients (both with and without diagnosed CKD) to determine whether discriminatory stressors are an important risk factor for CKD-related physiological processes and kidney functioning. The long-term goal of this research program is to understand the impact of and pathways through which discriminatory stress contributes to CKD progression. The overall objective of this R21 application, which is the first step towards attainment of this long-term goal, is to obtain effect sizes for a larger prospective R01 and explore two hypothesized pathways (i.e., blood pressure reactivity and pathophysiological mechanisms) using a multi-method research design. This study will carry out the following specific aims: 1. To examine associations between chronic stressors (i.e., discriminatory versus general), pathophysiological mechanisms (i.e., elevated inflammation and nocturnal blood pressure), and poor kidney functioning among 100 African American patients. a. Based on a cross-sectional research design, we hypothesize that chronic discriminatory stressors will be associated with poor kidney functioning independent of other chronic stressors as mediated by CKD-related inflammatory biomarkers and autonomic arousal. 2. To examine the impact of acute stressors (i.e., discriminatory versus general) on short-term changes in CKD-related physiological processes (i.e., increases in inflammatory markers and blood pressure reactivity) in patients from aim 1. a. Based on an experimental research design, we hypothesize that discriminatory stressors will be more physiologically impactful than general stressors. Outcomes include several critical CKD-related inflammatory biomarkers and blood pressure reactivity assessed at three time points during the experimental manipulation. Collectively, these outcomes are expected to support the advancement of science-based information about CKD that can be disseminated in order to improve health and quality of life.
Social Stress, Inflammation, and Chronic Kidney Disease among African Americans Project Narrative African Americans progress to late stage chronic kidney disease at a much faster rate than Whites. Biomedical explanations for this phenomenon are common, with virtually no research attention paid to the role of social stress. The proposed study would fill this gap by examining stress related to discrimination as it relates to physiological processes such as inflammation and blood pressure reactivity and kidney-related outcomes
