Association between allostatic load and chronic kidney disease: findings from the NHANES 2015-2018 study

The allostatic load (AL) is a composite measure of multisystem physiological dysregulation, reflecting the cumulative adverse effects of chronic stress on health outcomes. This study was conducted with the objective of elucidating the association between AL and chronic kidney disease (CKD) by analyzing data derived from a nationally representative cohort of U.S. adults.

We conducted a cross-sectional analysis based on data from the National Health and Nutrition Examination Survey (NHANES) spaning from 2015 to 2018. The AL was calculated based on laboratory assessments of eight biomarkers-systolic blood pressure (SBP), diastolic blood pressure, body mass index (BMI = weight [kg] divided by height [m²]), total cholesterol, high-density lipoprotein (HDL) cholesterol, glycated hemoglobin A1c (HbA1c), albumin (Alb), and C-reactive protein. Logistic regression models, adjusted for demographic and clinical covariates, along with weighted quantile sum regression, were employed to assess potential associations between AL and CKD.

9,495 participants were incorporated into our analysis. AL was found to be significantly positively associated with CKD in weighted logistic regression analysis (odds ratio = 1.27, 95% confidence interval: 1.22-1.33). Among the eight biomarkers comprising the AL index, HDL cholesterol, SBP, BMI, HbA1c, and Alb were identified as significant predictors of CKD risk in fully adjusted models (P < 0.001). Restricted cubic spline analysis confirmed a positive link between AL and CKD. Subgroup analyses further revealed a significant interaction effect of sex on the AL-CKD relationship.

This cross-sectional study elucidates the association between AL and CKD, highlighting the potential influence of demographic factors. Elevated AL were demonstrated to be in close association with increased CKD prevalence, with SBP and HbA1c identified as critical contributors to CKD risk. While these findings enhance comprehension of the link between AL and CKD, additional research is required for further validation.