Short sleep duration is associated with an elevated risk of proteinuria, a finding that could impact the clinical management of chronic kidney disease (CKD), researchers concluded from a new systematic review and meta-analysis.

When Wisit Cheungpasitporn, MD, of Mayo Clinic in Rochester, MN, and colleagues analyzed data from 9 observational studies that included 289,272 individuals, they found that short sleepers had a 1.47 times increased risk of proteinuria compared with non-short sleepers. The study found no significant association between short sleep duration and CKD, which most studies defined as an estimated glomerular filtration rate (eGFR) less than 60 mL/min/1.73 m2. Most of the studies included in the review and meta-analysis defined short sleep duration as less than 4–5 hours of sleep per night.

Proteinuria is a strong predictor of clinical progression of CKD. In patients with CKD, it may accelerate kidney disease progression to end-stage renal disease (ESRD).

Adequate sleep is critical for regulating body metabolism and various physiologic functions, the authors explained. Some studies have shown association between short sleep duration (less than 7 hours) and co-morbid conditions such as diabetes mellitus, hypertension, obesity, and cardiovascular disease. In addition, they noted that sleep is a key regular of blood pressure and GFR.

“During normal sleep, reduced sympathetic activity and increased vagal tone, particularly during non-rapid eye movement sleep, are responsible for the nocturnal dipping of blood pressure associated with sleep,” they wrote. “Thus, reduced sleep duration may lead to sympathetic nervous system stimulation and attenuation of the sleep-induced decrease in blood pressure.”

In a separate study of women in the Nurses’ Health Study published recently in Kidney International, Ciaran J. McMullan, MD, and colleagues found that shorter sleep duration (6 hours or less) was associated with more rapid declines in eGFR. Compared with sleeping 7–8 hours per night, sleeping for 5 or fewer hours and 6 hours per night was associated with a significant 79% and 31% increased odds of  a rapid decline in eGFR, respectively, in adjusted analyses.