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Renoprotective effects of continuous positive airway pressure in chronic kidney disease patients with sleep apnea

  • Nephrology - Original article
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Abstract

Purpose

Chronic kidney disease (CKD) is associated with a high incidence of obstructive sleep apnea (OSA). We assessed the effect of continuous positive airway pressure (CPAP) on renal function in patients with CKD and OSA.

Methods

In this retrospective cohort study, 42 patients with Stage 3–5 CKD and OSA were stratified into two groups: patients who use CPAP more (average >4 h/night on >70 % of nights) and patients who use CPAP less (average ≤4 h/night on ≤70 % of nights). Median follow-up time was 2.3 (1.6–2.9) years for greater and 2.0 (0.6–3.5) years for lesser CPAP users. Chart reviews were carried out to record clinical characteristics, proteinuria measurements by urine dipstick, and eGFR values calculated by CKD–EPI equations. Univariate analyses were performed using Wilcoxon rank-sum and Kruskal–Wallis tests. Multivariate logistic regression models were applied to assess eGFR decline after CPAP prescription.

Results

Twelve (29 %) of the 42 subjects used CPAP more. Groups were similar with respect to age, body mass index, blood pressure, Charlson Comorbidity Index, and baseline eGFR and proteinuria. The median rate of decline of eGFR was significantly slower at −0.07 mL/min/1.73 m2/year (range −30 to 13) in those who used more CPAP compared to those who used it less at −3.15 mL/min/1.73 m2/year (range −27 to 7) (p = 0.027).Greater use of CPAP was also associated with a significantly reduced level of proteinuria at 0.15 (range 0.0–3.0) versus 0.70 g/L (range 0.0–3.0) (p = 0.046). Less compliant CPAP users were more likely to have progressive decline of eGFR (decline >3 mL/min/1.73 m2/year), with unadjusted OR 5.0 (95 % CI 0.93–26.8) and adjusted OR 8.9 (95 % CI 1.1–72.8), adjusting for CCI and baseline eGFR.

Conclusions

Compliance to CPAP therapy is associated with a slower rate of progression of CKD in patients with CKD and OSA.

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Authors and Affiliations

  1. 115-1745 Cedar Avenue, Montreal, QC, H3G 1A7, Canada

    Robert Puckrin

  2. McGill University Health Centre, Montreal, QC, Canada

    Sameena Iqbal, Arnold Zidulka, Murray Vasilevsky & Paul Barre

Authors
  1. Robert Puckrin
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  2. Sameena Iqbal
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  3. Arnold Zidulka
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  4. Murray Vasilevsky
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  5. Paul Barre
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Correspondence to Robert Puckrin.

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Conflict of interest

The authors declare they have no conflict of interest, and no disclosure of grants or funding to make. The research protocol was approved by the institutional Research Ethics Board and designed and conducted in accordance with the Declaration of Helsinki. For this type of study formal consent is not required.

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Puckrin, R., Iqbal, S., Zidulka, A. et al. Renoprotective effects of continuous positive airway pressure in chronic kidney disease patients with sleep apnea. Int Urol Nephrol 47, 1839–1845 (2015). https://doi.org/10.1007/s11255-015-1113-y

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  • DOI: https://doi.org/10.1007/s11255-015-1113-y

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