Poor Sleep Associated With Progression to ESRD
Patients with chronic kidney disease who sleep fewer than 5 hours are at 2-fold higher risk of advancing to end-stage renal disease.
Patients with chronic kidney disease (CKD) who sleep poorly or excessively have increased risks for progression to end stage renal disease (ESRD), according to findings from a new Japanese study.
In the CKD Japan Cohort (CKD-JAC) Study, 1601 patients with a baseline estimated glomerular filtration rate (eGFR) of 10 to 59 mL/min/1.73m2 reported a sleep duration of 4 hours on median and 7 hours on average. In addition, 37% indicated poor sleep quality on the Pittsburgh Sleep Quality Index (PSQI) questionnaire with scores of 6 and higher.
One in 5 of patients (18%) progressed to ESRD over 4 years, Ryohei Yamamoto, MD, of Osaka University, and colleagues reported in the Clinical Journal of the American Society of Nephrology. Investigators observed a U-shaped relationship between sleep duration and ESRD with shorter and longer sleep associated with greater risks. Sleeping fewer than 5 hours or longer than 8 hours were associated with a significant 2- and 1.5-fold increased ESRD risk, respectively, compared with sleeping 6.1 to 7 hours. PSQI global scores of 6 or higher also correlated with a 33% higher risk for ESRD, compared with lower scores. The team adjusted models for age, sex, eGFR, urinary albumin excretion, smoking, body mass index, diabetes, cardiovascular disease, systolic blood pressure, renin-angiotensin system blockade, hypnotics, and Beck depression inventory score.
“These results suggest that a quick assessment of self-reported sleep duration and sleep quality might be an easy and effective way to identify patients with CKD at high risk of ESKD,” Dr Yamamoto and colleagues stated.
Several previous cohort studies have linked shorter sleep with proteinuria and decline in kidney function, but the current study is one of a just a few looking at its relationship with progression to ESRD.
Yamamoto R, Shinzawa M, Isaka Y, et al. Sleep quality and sleep duration with CKD are associated with progression to ESKD. Clin J Am Soc Nephrol. DOI:10.2215/CJN.01340118