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Associations of sleeping patterns and isotemporal substitution of other behavior with the prevalence of CKD in Chinese adults

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Abstract

Studies have found a U-shaped relationship between sleep duration and chronic kidney disease (CKD) risk, but limited research evaluated the association of reallocating excessive sleep to other behavior with CKD. We included 104 538 participants from the nationwide cohort of the Risk Evaluation of Cancers in Chinese Diabetic Individuals: A Longitudinal Study, with self-reported time of daily-life behavior. Using isotemporal substitution models, we found that substituting 1 h of sleeping with sitting, walking, or moderate-to-vigorous physical activity was associated with a lower CKD prevalence. Leisure-time physical activity displacement was associated with a greater prevalence reduction than occupational physical activity in working population. In stratified analysis, a lower CKD prevalence related to substitution toward physical activity was found in long sleepers. More pronounced correlations were observed in long sleepers with diabetes than in those with prediabetes, and they benefited from other behavior substitutions toward a more active way. The U-shaped association between sleep duration and CKD prevalence implied the potential effects of insufficient and excessive sleep on the kidneys, in which the pernicious link with oversleep could be reversed by time reallocation to physical activity. The divergence in the predicted effect on CKD following time reallocation to behavior of different domains and intensities and in subpopulations with diverse metabolic statuses underlined the importance of optimizing sleeping patterns and adjusting integral behavioral composition.

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Acknowledgements

The authors thank all the staff and study participants for their important contributions. This work was supported by the grants from the National Natural Science Foundation of China (Nos. 82088102, 91857205, 82022011, 81970728, and 81930021), the Shanghai Rising-Star Program (No. 21QA1408100), Shanghai Outstanding Academic Leaders Plan (No. 20XD1422800), the National Top Young Scholar Program (Yu Xu), the Innovative Research Team of High-Level Local Universities in Shanghai, the Shanghai Clinical Research Center for Metabolic Diseases (No. 19MC1910100) and the Shanghai Shen Kang Hospital Development Center (Nos. SHDC2020CR1001A and SHDC2020CR3064B).

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Author notes

  1. Yi Ding and Xiaoli Xu contributed equally to the work.

Authors and Affiliations

  1. Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China

    Yi Ding, Xiaoli Xu, Zhuojun Xin, Qiuyu Cao, Jiaojiao Huang, Xianglin Wu, Min Xu, Tiange Wang, Zhiyun Zhao, Yuhong Chen, Jieli Lu, Weiqing Wang, Guang Ning, Yu Xu, Yufang Bi & Mian Li

  2. Shanghai National Clinical Research Center for Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of China, Shanghai Key Laboratory for Endocrine Tumor, State Key Laboratory of Medical Genomics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China

    Yi Ding, Xiaoli Xu, Zhuojun Xin, Qiuyu Cao, Jiaojiao Huang, Xianglin Wu, Min Xu, Tiange Wang, Zhiyun Zhao, Yuhong Chen, Jieli Lu, Weiqing Wang, Guang Ning, Yu Xu, Yufang Bi & Mian Li

  3. Jiangxi Provincial People’s Hospital, Affiliated to Nanchang University, Nanchang, 330000, China

    Yanan Huo

  4. Department of Endocrinology, The Affiliated Hospital of Southwest Medical University, Luzhou, 646000, China

    Qin Wan

  5. Department of Endocrinology, The First Affiliated Hospital of Guangxi Medical University, Nanning, 530000, China

    Yingfen Qin & Zuojie Luo

  6. Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, 310000, China

    Ruying Hu & Zhen Ye

  7. Department of Endocrinology, Affiliated Hospital of Guiyang Medical University, Guiyang, 550000, China

    Lixin Shi

  8. Xinhua Hospital, Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200000, China

    Qing Su

  9. Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430000, China

    Xuefeng Yu

  10. Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, 510000, China

    Li Yan

  11. Department of Endocrinology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450000, China

    Guijun Qin

  12. Department of Endocrinology, The First Hospital of Lanzhou University, Lanzhou, 730000, China

    Xulei Tang

  13. Fujian Provincial Hospital, Fujian Medical University, Fuzhou, 350000, China

    Gang Chen

  14. Dalian Municipal Central Hospital, Affiliated of Dalian Medical University, Dalian, 116000, China

    Zhengnan Gao

  15. Department of Endocrinology, The First Hospital of Jilin University, Changchun, 130000, China

    Guixia Wang

  16. Department of Endocrinology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, China

    Feixia Shen

  17. Qilu Hospital of Shandong University, Jinan, 250000, China

    Li Chen

  18. Department of Endocrinology, The Second Affiliated Hospital of Harbin Medical University, Harbin, 150000, China

    Qiang Li

  19. Department of Endocrinology, Central Hospital of Shanghai Jiading District, Shanghai, 200000, China

    Yinfei Zhang

  20. Department of Endocrinology, Jiangsu Province Hospital on Integration of Chinese and Western Medicine, Nanjing, 210000, China

    Chao Liu

  21. Department of Endocrinology, The First Affiliated Hospital of Anhui Medical University, Hefei, 230000, China

    Youmin Wang

  22. Department of Endocrinology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210000, China

    Tao Yang

  23. Department of Endocrinology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 410000, China

    Huacong Deng

  24. Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430000, China

    Lulu Chen & Tianshu Zeng

  25. Shandong Provincial Hospital, Affiliated to Shandong University, Jinan, 250000, China

    Jiajun Zhao

  26. Department of Endocrinology, Chinese People’s Liberation Army General Hospital, Beijing, 100000, China

    Yiming Mu

  27. Department of Endocrinology, Karamay Municipal People’s Hospital, Karamay, 834000, China

    Shengli Wu

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  1. Yi Ding
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  2. Xiaoli Xu
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  40. Weiqing Wang
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  41. Guang Ning
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  42. Yu Xu
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  43. Yufang Bi
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  44. Mian Li
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Corresponding authors

Correspondence to Yu Xu, Yufang Bi or Mian Li.

Ethics declarations

Conflicts of interest Yi Ding, Xiaoli Xu, Zhuojun Xin, Qiuyu Cao, Jiaojiao Huang, Xianglin Wu, Yanan Huo, Qin Wan, Yingfen Qin, Ruying Hu, Lixin Shi, Qing Su, Xuefeng Yu, Li Yan, Guijun Qin, Xulei Tang, Gang Chen, Min Xu, Tiange Wang, Zhiyun Zhao, Zhengnan Gao, Guixia Wang, Feixia Shen, Zuojie Luo, Li Chen, Qiang Li, Zhen Ye, Yinfei Zhang, Chao Liu, Youmin Wang, Tao Yang, Huacong Deng, Lulu Chen, Tianshu Zeng, Jiajun Zhao, Yiming Mu, Shengli Wu, Yuhong Chen, Jieli Lu, Weiqing Wang, Guang Ning, Yu Xu, Yufang Bi, and Mian Li declare that they have no conflict of interest.

The study was approved (or granted exemption) by the Medical Ethics Committee of Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine and the study was performed in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards. Informed consent was obtained from all patients for being included in the study.

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Ding, Y., Xu, X., Xin, Z. et al. Associations of sleeping patterns and isotemporal substitution of other behavior with the prevalence of CKD in Chinese adults. Front. Med. (2023). https://doi.org/10.1007/s11684-023-1019-5

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