The Effects of Kidney Transplantation on Sleep, Melatonin, Circadian Rhythm and Quality of Life in Kidney Transplant Recipients and Living Donors

Abstract

Background: Sleep disturbance is an important medical problem in patients with end-stage renal disease. It might be related to the disruption of the body's circadian clock since nocturnal levels of its key biomarker melatonin are markedly reduced. We aimed at investigating whether a change in renal function due to kidney transplantation or donation would modify sleep, melatonin levels, circadian rhythmicity, and quality of life in kidney transplant recipients (KTR) and living donors (LD). Methods: In KTR, we assessed saliva melatonin concentrations, sleep quality and daytime sleepiness prior to and at 2 weeks and 3 months after transplantation. In LD, we assessed these parameters prior to and at 3 months after donation. We additionally assessed 24-hour core body temperature (cBT), 24-hour blood pressure profile, and quality of life (QoL) prior to and 3 months after transplantation. Results: Twenty-three KTR and 23 LD completed the study. Regarding sleep, the amount of nighttime awake minutes tended to be reduced in recipients after transplantation (p = 0.05). Nocturnal melatonin concentrations did not change with transplantation or donation. Blood pressure dipping profile and the two circadian markers dim-light melatonin onset and time of core body temperature minimum did not change. Nevertheless, KTR reported that daytime sleepiness and QoL had improved. Conclusion: Objectively nocturnal sleep quality marginally improved after transplantation. Subjectively patients reported improved QoL and daytime sleepiness scores. Changes in renal function were not associated with modified melatonin secretion or circadian rhythmicity.

Potential benefits of melatonin in organ transplantation: a review

“…However, melatonin levels in control subjects were similar to those in the intervention group, and behaviorally the patients showed significant statistical improvement as a result of melatonin. These results are in agreement with other studies (Russcher et al 2015). In the latter case, the authors also did not observe beneficial effects on sleep quality due to melatonin-mediated improvement of renal function after transplantation; conversely, in an unpublished claim, kidney transplantation was associated with a rise of melatonin levels and an improvement in sleep quality due to the recovery of organ function (M Russcher, B C P Koch, C A J M Gaillard, J E Nagtegaal & P M Ter Wee, unpublished observations).…”

Melatonin rhythms in renal transplant recipients with sleep–wake disturbances

“…Melatonin amplitude and melatonin rhythm have been shown to decrease in chronic kidney disease patients with advancing renal dysfunction (Koch et al, 2010). There is only one study of 23 RTx recipients with saliva melatonin measurements at preTx and 3 months post-Tx (Russcher et al, 2015). Although melatonin values were low in this study, the DLMO was always calculable.…”

The effect of renal transplantation on quality of sleep in former dialysis patients

“…In cross‐sectional studies, the quality of sleep seems better in RTX patients compared to dialysis patients . To our knowledge, only one longitudinal study has assessed sleep with polysomnography in renal patients in the transition from dialysis to transplantation , while there is no study exploring self‐perceived quality of sleep. Cross‐sectional studies have shown that patients who have received a renal graft have less sleep apnoea and reduced PLMD .…”