Jun Ling Lu1, Amado X Freire2, Miklos Z Molnar3, Kamyar Kalantar-Zadeh4, Csaba P Kovesdy5. 1. Division of Nephrology, University of Tennessee Health Science Center, Memphis. 2. Division of Pulmonary, Critical Care and Sleep Medicine, University of Tennessee Health Science Center, Memphis; Pulmonary Section, Memphis VA Medical Center, Memphis, TN. 3. Division of Nephrology, University of Tennessee Health Science Center, Memphis; Division of Transplant Surgery, Department of Surgery, University of Tennessee Health Science Center, Memphis; Division of Transplant Surgery, Methodist University Hospital Transplant Institute, Memphis, TN; Department of Transplantation and Surgery, Semmelweis University, Budapest, Hungary. 4. Harold Simmons Center for Chronic Disease Research and Epidemiology, Division of Nephrology and Hypertension, University of California, Irvine Medical Center, Orange. 5. Division of Nephrology, University of Tennessee Health Science Center, Memphis; Nephrology Section, Memphis VA Medical Center, Memphis, TN. Electronic address: ckovesdy@uthsc.edu.
Abstract
OBJECTIVE: To examine whether chronic insomnia is associated with an increased risk of adverse renal outcomes and all-cause mortality. PATIENTS AND METHODS: We examined associations of chronic insomnia (defined as the presence of both International Classification of Diseases, Ninth Revision codes 307.42, 307.49, and 780.52 and long-term use of insomnia medications) with adverse renal outcomes (end-stage renal disease, incidence of estimated glomerular filtration rate [eGFR] ≤45 mL/min per 1.73 m2, and eGFR slopes <-3.0 mL/min per 1.73 m2 per year) and all-cause mortality in a national cohort of 1,639,090 US veterans by using Cox proportional hazards and logistic regression models with multivariable adjustments. RESULTS: A total of 36,741 patients (2.24%) had chronic insomnia; 32,985 (89.8%) were male and 28,090 (76.5%) were white, with a mean baseline eGFR of 84.1±16.4 mL/min per 1.73 m2. Chronic insomnia was associated with a significantly higher risk of eGFR 45 mL/min per 1.73 m2 or less (multivariable-adjusted hazard ratio [HR], 1.39; 95% CI, 1.34-1.44; P<.001), and rapid loss of kidney function (odds ratio, 1.07; 95% CI, 1.03-1.12; P=.002), but not end-stage renal disease (HR, 1.25; 95% CI, 0.81-1.93; P=.32). Chronic insomnia was not associated with a higher risk of all-cause mortality (HR, 1.00; 95% CI, 0.97-1.03; P=.99). CONCLUSION: Chronic insomnia is associated with a higher risk of development and progression of chronic kidney disease, but not ESRD. Further studies are needed to establish the underlying mechanisms of action and to determine whether treatment of insomnia could be beneficial to prevent deteriorating kidney function. Published by Elsevier Inc.
OBJECTIVE: To examine whether chronic insomnia is associated with an increased risk of adverse renal outcomes and all-cause mortality. PATIENTS AND METHODS: We examined associations of chronic insomnia (defined as the presence of both International Classification of Diseases, Ninth Revision codes 307.42, 307.49, and 780.52 and long-term use of insomnia medications) with adverse renal outcomes (end-stage renal disease, incidence of estimated glomerular filtration rate [eGFR] ≤45 mL/min per 1.73 m2, and eGFR slopes <-3.0 mL/min per 1.73 m2 per year) and all-cause mortality in a national cohort of 1,639,090 US veterans by using Cox proportional hazards and logistic regression models with multivariable adjustments. RESULTS: A total of 36,741 patients (2.24%) had chronic insomnia; 32,985 (89.8%) were male and 28,090 (76.5%) were white, with a mean baseline eGFR of 84.1±16.4 mL/min per 1.73 m2. Chronic insomnia was associated with a significantly higher risk of eGFR 45 mL/min per 1.73 m2 or less (multivariable-adjusted hazard ratio [HR], 1.39; 95% CI, 1.34-1.44; P<.001), and rapid loss of kidney function (odds ratio, 1.07; 95% CI, 1.03-1.12; P=.002), but not end-stage renal disease (HR, 1.25; 95% CI, 0.81-1.93; P=.32). Chronic insomnia was not associated with a higher risk of all-cause mortality (HR, 1.00; 95% CI, 0.97-1.03; P=.99). CONCLUSION:Chronic insomnia is associated with a higher risk of development and progression of chronic kidney disease, but not ESRD. Further studies are needed to establish the underlying mechanisms of action and to determine whether treatment of insomnia could be beneficial to prevent deteriorating kidney function. Published by Elsevier Inc.
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