Kidney Week

Abstract: FR-PO435

Sleep Apnea and CKD Progression: A Prospective Observational Study

Session Information

• CKD: Risk Factors for Incidence and Progression - II
  November 03, 2017 | Location: Hall H, Morial Convention Center
  Abstract Time: 10:00 AM - 10:00 AM

Category: Chronic Kidney Disease (Non-Dialysis)

• 301 CKD: Risk Factors for Incidence and Progression

Authors

• Canales, Muna T., Malcom Randall VAMC & Univ. of Florida, Gainesville, Florida, United States

Muna T. Canales,

• Bozorgmehri, Shahab, University of Florida, Gainesville, Florida, United States

Shahab Bozorgmehri,

• Ishani, Areef, Dept of VA & Univ. of Minnesota, Minneapolis, Minnesota, United States

Areef Ishani,

• Weiner, I. David, Malcom Randall VAMC & Univ. of Florida, Gainesville, Florida, United States

I. David Weiner,

• Berry, Richard, Malcom Randall VAMC & Univ. of Florida, Gainesville, Florida, United States

Richard Berry,

• Beyth, Rebecca, Malcom Randall VAMC & Univ. of Florida, Gainesville, Florida, United States

Rebecca Beyth,

Background

Studies using retrospective data analysis or using diagnostic codes have suggested that sleep apnea (SA) accelerates kidney function decline. We report an interim analysis of the first large, prospective study in CKD assessing this interaction.

Methods

This is a planned 2-year interim analysis of the SNORE Study, an ongoing 3-year prospective study of 248 Veterans aged 18-89 years with eGFR 15-44 ml/min/1.73m² who were not on treatment for SA at time of enrollment. At baseline, Veterans underwent an overnight sleep study, and estimation of renal function (serum creatinine, SCr). Renal function was re-assessed annually and intercurrent SCr measures were obtained from the computerized medical record. We determined the association between baseline SA (defined by the apnea-hypopnea index, AHI) and 1) MDRD eGFR trajectory; and 2) risk of 30% decline in MDRD eGFR using linear mixed modeling and cox-proportional hazards regression, respectively.

Results

At entry into the study, mean ±SD age was 73±10 years; 95% were male; 78% were white; mean (±SD) body-mass-index(BMI) was 30±5 kg/m²; 96% had HTN; and 55% had DM. Mean follow-up at time of this planned interim analysis was 2.2 ± 0.8 years. Median [IQR] number of SCr values was 10 [6-16]. Mean MDRD eGFR was 35±9 ml/min/1.73m². Median [IQR] AHI was 10 [4-22]. The proportion with no, mild, moderate or severe SA were 29%, 32%, 19%, and 20%, respectively. EGFR decline was faster among those with moderate to severe SA (-1.68 ± 0.61 ml/min/1.73m²/year) vs none or mild SA (-0.68 ± 0.39 ml/min/1.73m²/year) but this was not statistically significant (p = 0.10). Moderate to severe SA was associated with a 58% increased risk of 30% decline in eGFR, despite adjustment for age and BMI (p=0.05) as compared to those with none or mild SA.

Conclusion

Among Veterans with CKD, the presence of moderate to severe SA is associated with a faster decline in eGFR and increased risk of 30% decline in eGFR over 2 years, but findings are of borderline statistical significance. Completion of 3-year follow-up as planned will provide additional power to make more definitive conclusions regarding the association between SA and CKD progression in this population.

Funding

• Veterans Affairs Support