Association of Nocturnal Hypoxemia with Progression of CKD

Sakaguchi, Yusuke; Hatta, Tsuguru; Hayashi, Terumasa; Tanaka, Shōji; Suzuki, Akira; Tomida, Kodo; Okada, Noriyuki; Rakugi, Hiromi; Isaka, Yoshitaka; Tsubakihara, Yoshiharu

doi:10.2215/cjn.11931112

Cited by 55 publications

(47 citation statements)

References 48 publications

(50 reference statements)

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“…[270][271][272][273][274][275][276] In addition, cohort studies of the longitudinal relationship between sleep apnea and kidney function show that apnea is independently associated with an increased risk of accelerated loss of kidney function. 277,278 Conversely, as kidney function declines, the prevalence of sleep apnea and nocturnal hypoxia increases. 272 Furthermore, aggressive dialysis has been found to improve obstructive sleep apnea.…”

Section: Repeated Episodes Of Acute Kidney Injurymentioning

confidence: 99%

Hypoxia: The Force that Drives Chronic Kidney Disease

Colgan

Shelley

2016

Clinical Medicine & Research

120

111

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In the United States the prevalence of end-stage renal disease (ESRD) reached epidemic proportions in 2012 with over 600,000 patients being treated. The rates of ESRD among the elderly are disproportionally high. Consequently, as life expectancy increases and the baby-boom generation reaches retirement age, the already heavy burden imposed by ESRD on the US health care system is set to increase dramatically. ESRD represents the terminal stage of chronic kidney disease (CKD). A large body of evidence indicating that CKD is driven by renal tissue hypoxia has led to the development of therapeutic strategies that increase kidney oxygenation and the contention that chronic hypoxia is the final common pathway to end-stage renal failure. Numerous studies have demonstrated that one of the most potent means by which hypoxic conditions within the kidney produce CKD is by inducing a sustained inflammatory attack by infiltrating leukocytes. Indispensable to this attack is the acquisition by leukocytes of an adhesive phenotype. It was thought that this process resulted exclusively from leukocytes responding to cytokines released from ischemic renal endothelium. However, recently it has been demonstrated that leukocytes also become activated independent of the hypoxic response of endothelial cells. It was found that this endothelium-independent mechanism involves leukocytes directly sensing hypoxia and responding by transcriptional induction of the genes that encode the β2-integrin family of adhesion molecules. This induction likely maintains the long-term inflammation by which hypoxia drives the pathogenesis of CKD. Consequently, targeting these transcriptional mechanisms would appear to represent a promising new therapeutic strategy.

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Section: Repeated Episodes Of Acute Kidney Injurymentioning

confidence: 99%

Hypoxia: The Force that Drives Chronic Kidney Disease

Colgan

Shelley

2016

Clinical Medicine & Research

120

111

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“…Reports of recent longitudinal clinical studies have described SDB as an independent risk factor of accelerated kidney function loss in patients with CKD (4,13). Sakaguchi et al investigated 161 nonobese patients with stages 3-4 CKD and found that nocturnal hypoxemia is an independent risk factor of a rapid decline in kidney function (4). Our results demonstrated that receiving HD was significantly associated with higher risk of SDB, whereas the presence of advanced CKD (stages 3-4 of CKD) was not associated with SDB even after reclassifying the CKD stage based on eGFR using the Modification of Diet in Renal Disease equation (32), possibly because of the small number of those patients.…”

Section: Discussionmentioning

confidence: 99%

“…Sleep-disordered breathing (SDB), a disorder characterized by recurrent arousal from sleep and intermittent hypoxemia, is highly prevalent among individuals with CKD, affecting as many as 65% of patients (1)(2)(3)(4). Nocturnal intermittent hypoxemia attributable to SDB causes oxidative stress by increasing the generation of reactive oxygen species (ROS), which induces hypoxiainducible factor (HIF)-1a (5), activates the sympathetic nervous system (6) and the renin-angiotensin system (7), and promotes vascular inflammation, causing vascular calcification and atherosclerosis (8,9).…”

Section: Introductionmentioning

confidence: 99%

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Sleep-Disordered Breathing in Patients with Polycystic Liver and Kidney Disease Referred for Transcatheter Arterial Embolization

Sumida

Hoshino

Suwabe

et al. 2015

Clinical Journal of the American Society of Nephrology

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Background and objectives Sleep-disordered breathing (SDB) is prevalent among patients with CKD, but its prevalence among patients with symptomatic autosomal dominant polycystic kidney disease (ADPKD) and its association with total liver and kidney volume remain unclear.Design, setting, participants, & measurements This study examined the association between height-adjusted total liver and kidney volume (htTLKV) and SDB in a cross-sectional study of 304 adult patients with symptomatic ADPKD who were hospitalized at Toranomon Hospital for transcatheter arterial embolization and who underwent pulse oximetry between April 2008 and November 2013. SDB was defined as having a 3% oxygen desaturation index of $15 events per hour of sleep. Logistic regression was performed with sex-specific quartiles of htTLKV as the main predictor, using patient data and comorbidities as covariates.Results Overall (54.6% women, mean age 56.269.4 years, 83.5% on hemodialysis), 177 of 304 patients (58.2%) had SDB. SDB was strongly associated with htTLKV quartiles, demonstrating that odds ratios (ORs) and 95% confidence intervals (95% CIs) for SDB were 1.63 (0.76 to 3.48), 2.35 (1.09 to 5.06), and 4.61 (1.98 to 10.7) for htTLKV quartiles 2-4 (P for trend, P=0.003), respectively. Older age (OR, 1.81 per 10 years; 95% CI, 1.29 to 2.55), male sex (OR, 3.87; 95% CI, 1.96 to 7.66), receiving hemodialysis (OR, 3.46; 95% CI, 1.62 to 12.1), and higher body mass index ($25 kg/m 2 ) (OR, 3.03; 95% CI, 1.08 to 8.52) were also associated with SDB.Conclusions In this highly selected population of patients with symptomatic ADPKD referred for transcatheter arterial embolization, SDB was highly prevalent and independently associated with higher htTLKV.Clin J Am Soc Nephrol 10: 949-956, 2015.

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“…In contrast, Sakaguchi et al evaluated 161 patients with stage 3-4 CKD (GFR: 31 mL/min per 1.73 m 2 ). 9 Fifty percent of patients had nocturnal hypoxemia, refl ected by the oxygen desaturation index (ODI). The decline in GFR over 1 year was 3-4 times greater in patients with ODI ≥ 15 than those with ODI < 15.…”

Section: Co M M E N Ta Rymentioning

confidence: 99%

Consider the Kidney when Managing Obstructive Sleep Apnea

Hanly

2015

Journal of Clinical Sleep Medicine

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Association of Nocturnal Hypoxemia with Progression of CKD

Cited by 55 publications

References 48 publications

Hypoxia: The Force that Drives Chronic Kidney Disease

Hypoxia: The Force that Drives Chronic Kidney Disease

Sleep-Disordered Breathing in Patients with Polycystic Liver and Kidney Disease Referred for Transcatheter Arterial Embolization

Consider the Kidney when Managing Obstructive Sleep Apnea

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