Csaba P. Kovesdy
Patients with chronic insomnia had a higher incidence of progressive loss of kidney function, incident chronic kidney disease and all-cause mortality in study findings presented at the American Society of Nephrology’s Kidney Week.
“Previous studies have showed that sleep disorders have adverse effects on the hypothalamic–pituitary–adrenal axis and/or the sympatho-adrenal system, which may cause abnormalities in the cardiovascular system and in metabolic pathways,” Csaba P. Kovesdy, MD, director of the clinical outcomes and clinical trials program, division of nephrology, University of Tennessee Health Science Center, told Healio Family Medicine. “However, there is inadequate evidence of an association between chronic insomnia and adverse renal outcomes.”
Researchers studied associations between chronic insomnia with all-cause mortality and renal outcomes including end-stage renal disease, estimated glomerular filtration (eGFR) rate of less than 45 mL/min/1.73 m2, and eGFR slopes of less than –3 mL/min/1.73 m2, in a cohort of 957,587 US veterans with an eGFR greater than 60 mL/min/1.73m2. .
Among the 41,928 patients (4.4%) who had chronic insomnia, over a median 6.1-year follow-up period, 23.1% died, 6.6% progressed to eGFR rate of less than 45 mL/min/1.73 m2, 2.7% displayed rapid progression, and 0.2% reached end-stage renal disease. After adjusting for antihypertensive drugs, baseline eGFR rate, BMI, BP, comorbidities, crude models, demographics and socioeconomic status, Kovesdy and colleagues determined that insomnia was linked to a higher risk for rapid loss of kidney function (OR = 1.46; 95% CI, 1.33-1.62); all-cause mortality (HR = 1.43; 95% CI, 1.37–1.48); end-stage renal disease (HR = 2.41; 95% CI, 1.66–3.48) and eGFR rate of less than 45 mL/min/1.73 m2 (HR = 2.51; 95% CI, 2.39–2.64).
“Treatment of chronic insomnia could result in substantial benefits that go beyond subjective quality of life,” Kovesdy said. “Primary care physicians need to be aware of the associations we found, but since this is only observational data we cannot yet claim that treatment of insomnia will result in improved renal outcomes. Future studies are needed to determine which type of interventions to alleviate insomnia could efficiently improve clinical outcomes. – by Janel Miller
Li J, et al. Abstract 2771381. Presented at: American Society of Nephrology Kidney Week. Annual Meeting. Oct. 31–Nov. 5, 2017; New Orleans.
The authors report no relevant financial disclosures.