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Kidney Week

Abstract: SA-PO768

The Bidirectional Relationship Between CKD and Sleep Disordered Breathing

Session Information

  • CKD: Mechanisms - III
    November 09, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
    Abstract Time: 10:00 AM - 12:00 PM

Category: CKD (Non-Dialysis)

  • 2103 CKD (Non-Dialysis): Mechanisms

Authors

  • Figueroa rodriguez, Fernando, Beaumont Health, Troy, Michigan, United States
  • Mansuri, Saima, Beaumont Hospital, Royal oak, Michigan, United States
Background

The prevalence of Sleep Disordered Breathing (SDB) is higher in Chronic kidney disease (CKD) patients compared to the general population. The relationship between these two diseases is complex and bidirectional. SDB is linked to increased risk of hypertension, atherosclerosis and systemic inflammation which can accelerate the deterioration of renal function. On the other hand, CKD is associated with volume overload, metabolic abnormalities and hypertension contributing to the pathogenesis of SDB. Recognizing the association between them can lead to early treatment, better clinical outcomes and higher quality of life.

Methods

A retrospective study included 385 Beaumont Health System patients from 01/01/2012 to 12/31/2017 with diagnosis of both CKD and SDB. The objective was to observe the association of SDB across the CKD stages and proteinuria and to assess the relationship with sleep parameters identifying common predictors associated with these two conditions. SDB was confirmed by polysomnography. CKD diagnosis was based on Glomerular Filtration Rate (GFR) and urine albumin creatinine ratio (UACR).

Results

In patients with both SDB and CKD, there was an association between Apnea Hypopnea Index (AHI) and GFR (p=0.08) but not with UACR (p=0.59). 70 % of the patients with stage G2 & G3 CKD had moderate to severe AHI. The median decline in GFR was 5.5 ml/min/1.73 m2 per year and 12% had accelerated decline in GFR. There was a strong association between Nocturnal Hypoxia (NH) and AHI (p<0.0001) in CKD patients but none with GFR (p=0.60) or UACR (p=0.52). Patients on Renin Angiotensin System (RAAS) inhibitors and on Non-Steroidal Anti-inflammatory (NSAIDs) showed trend towards less severe AHI (p=0.03) and (p=0.06) respectively; those with systolic heart failure (HF) trended towards worse UACR values (p=0.02). There was no evidence that body mass index, gender, antidepressant or narcotic use is related to AHI severity or NH in CKD patients.

Conclusion

Overall, the severity of SDB tended to get worse with advanced CKD and vice versa: patients on RAAS inhibitors and NSAIDs showed less severe AHI, supporting the role of systemic inflammation and hypertension in the pathogenesis of SDB. It was also noted that patients with nocturnal hypoxia tended to have worse AHI and those with systolic HF had higher levels of proteinuria.