Habitual sleep and kidney function in chronic kidney disease: the Chronic Renal Insufficiency Cohort study

Abstract

Physiological evidence suggests that sleep modulates kidney function. Our objective was to examine the cross-sectional association between kidney function and objectively-estimated habitual sleep duration, quality and timing in a cohort of patients with mild to moderate chronic kidney disease. This study involved two US clinical centers of the Chronic Renal Insufficiency Cohort (CRIC) study, including 432 participants in a CRIC ancillary sleep study. Habitual sleep duration, quality and timing were measured using wrist actigraphy for 5-7 days. Validated sleep questionnaires assessed subjective sleep quality, daytime sleepiness and risk of sleep apnea. Kidney function was assessed with the estimated glomerular filtration rate using the Chronic Kidney Disease Epidemiology Collaboration equation, and the urinary protein to creatinine ratio. Lower estimated glomerular filtration rate was associated with shorter sleep duration (-1.1 mL min^-1 1.73 m^-2 per hour less sleep, P = 0.03), greater sleep fragmentation (-2.6 mL min^-1 1.73 m^-2 per 10% higher fragmentation, P < 0.001) and later timing of sleep (-0.9 mL min^-1 1.73 m^-2 per hour later, P = 0.05). Higher protein to creatinine ratio was also associated with greater sleep fragmentation (approximately 28% higher per 10% higher fragmentation, P < 0.001). Subjective sleep quality, sleepiness and persistent snoring were not associated with estimated glomerular filtration rate or protein to creatinine ratio. Thus, worse objective sleep quality was associated with lower estimated glomerular filtration rate and higher protein to creatinine ratio. Shorter sleep duration and later sleep timing were also associated with lower estimated glomerular filtration rate. Physicians treating patients with chronic kidney disease should consider inquiring about sleep and possibly sending for clinical sleep assessment. Longitudinal and interventional trials are needed to understand causal direction.

Keywords: circadian rhythms; nephrology; proteinuria; renal.

Figure 1.

Consort diagram.

Figure 2.

Mean eGFR and PCR levels over the quartiles of sleep duration, sleep fragmentation and sleep timing adjusted for age, race, sex, BMI, study site, systolic blood pressure and fasting glucose. PCR values have been back-transformed from ln(PCR) used in regression analyses. Error bars represent 95% CI from the regression analysis.