Objective sleep, a novel risk factor for alterations in kidney function: the CARDIA study

Abstract

Objective To determine the association between objectively measured sleep and 10-year changes in estimated glomerular filtration rate (eGFR). Methods From 2003 to 2005, an ancillary sleep study was conducted at the Chicago site of the Coronary Artery Disease in Young Adults (CARDIA) study. Community-based black and white adults (aged 32–51 years) wore a wrist actigraph up to six nights to record sleep duration and fragmentation. Sleep quality was measured with the Pittsburgh Sleep Quality Index (PSQI). Participants without history of cardiovascular or chronic kidney diseases, proteinuria, or hypertension at the 2000–2001 CARDIA examination were followed over 10 years (n = 463). eGFR was estimated from serum creatinine (eGFRCr) at the 2000–2001, 2005–2006, and 2010–2011 CARDIA examinations, whereas cystatin-C-estimated eGFR (eGFRCys) was measured at the 2000–2001 and 2005–2006 examinations. Generalized estimating equation regression and linear models estimated the associations of each sleep parameter with changes in eGFRCr and eGFRCys, controlling for cardiovascular and renal risk. Results Sleep parameters were not related to 5-year change in eGFRCys. However, each 1 h decrease in sleep duration was significantly associated with a 1.5 mL/min/1.73 m2 higher eGFRCr [95% confidence interval (CI), 0.2–2.7], and each one-point increase in PSQI was significantly associated with a 0.5 mL/min/1.73 m2 higher eGFRCr (95% CI, 0.04–0.9) over 10 years. Conclusion In this community-based sample, shorter sleep and poorer sleep quality were related to higher kidney filtration rates over 10 years.

Association of short sleep duration and rapid decline in renal function

“…The second, substantially smaller prospective study of 463 adults found that the adjusted risk of a 10-year decline in eGFR of >3% was 0.83 (95% CI 0.64 – 1.08) per additional hour of sleep per night; this potential benefit from additional sleep (or, reciprocally, a determent from less sleep) was not statistically significant, possibly due low statistical power. (15) Consistent with their observations, we found that shorter sleep duration was significantly and independently associated with faster annualized decline in eGFR and a greater risk of having a ≥30% decline in eGFR at 11 years.…”

Self-reported sleep duration and daytime napping are associated with renal hyperfiltration and microalbuminuria in apparently healthy Chinese population

“…Several studies had investigated the association between sleep and kidney health outcome. Both short and long sleep duration were reported to be associated with decreased eGFR and the progression to ESRD among CKD 12, 21, 32, 33 or hypertension 18 population, and to be associated with increased eGFR, hyperfiltration, inadequate hydration and the prevalence of CKD among community-based general population 13, 19, 20, 26–28 . In our study, based on same general community population, we further demonstrated that inappropriate sleep duration had converse effects on eGFR in healthy or early-stage nephropathy population, which was consistent to previous studies.…”

“…Recently, a series of studies suggested extreme sleep duration may contribute to the decline of kidney function, which is closely tied to the vascular system, also an important, independent risk factor for cardiovascular disease. Both extremely short 11, 12 and long 13 sleep duration and poor sleep quality 14, 26 were reported to be related to higher urine albumin-to-creatinine ratio(UACR), which is a sensitive indicator for microalbuminuria or early stage of kidney damage, among US and Japanese population. In addition, short sleep duration was associated with higher odds of inadequate hydration 15 .…”

“…Several studies have demonstrated an increasing risk of CKD16,17 or lower GFR12,18,19,20,21 in short sleepers, but a few studies have shown no correlation between sleep duration and CKD22-25. Conversely, there were both cross-sectional or cohort studies which have reported inappropriate sleep duration contributes to glomerular hyperfiltration 13, 26–28 . This difference in outcomes can be attributed not only to differences in race, age, social work stress, health and economic status of the participants, but also to the fact that in the progression of CKD, healthy individuals tend to have glomerular hyperfiltration initially, followed by increased risk for renal injury, leading to a decrease in filtration rate and accelerating development of CKD.…”

Biobehavioral variation in human water needs: How adaptations, early life environments, and the life course affect body water homeostasis

“…The recommendation is 7 to 9 hours for optimal health (Consensus Conference, ). Previous research has shown that shorter sleep reduced kidney function and filtration rate 10 years later (Petrov et al, ). However, few studies have examined how sleep duration is associated with hydration status beyond anecdotal reports of sleep‐restricted participants reporting trouble with blood draws due to dehydration (Opstad, ).…”