Kidney Week

Abstract: FR-PO510

Association of Chronic Insomnia with Mortality and Adverse Renal Outcomes

Session Information

• CKD: Epidemiology, Outcomes - Non-Cardiovascular - I
  November 03, 2017 | Location: Hall H, Morial Convention Center
  Abstract Time: 10:00 AM - 10:00 AM

Category: Chronic Kidney Disease (Non-Dialysis)

• 304 CKD: Epidemiology, Outcomes - Non-Cardiovascular

Authors

• Lu, Jun Ling, University of Tennessee Health Science Center, Memphis, Tennessee, United States

Jun Ling Lu,

• Freire, Amado X, UTHSC at Memphis, Memphis, Tennessee, United States

Amado X Freire,

• Molnar, Miklos Zsolt, University of Tennessee Health Science Center, Memphis, Tennessee, United States

Miklos Zsolt Molnar,

• Kalantar-Zadeh, Kamyar, University of California Irvine, School of Medicine, Orange, California, United States

Kamyar Kalantar-Zadeh,

• Kovesdy, Csaba P., University of Tennessee Health Science Center, Memphis, Tennessee, United States

Csaba P. Kovesdy,

Background

Chronic insomnia is highly prevalent in the world. Its effects on the sympatho-adrenal system could potentially worsen hypertension and cause metabolic abnormalities. However, there is lack of evidence of the association between insomnia and adverse renal outcomes.

Methods

We examined associations of chronic insomnia (defined as the presence of ICD9 codes 307.42, 307.49 and 780.52 and long-term use of insomnia medications) with all-cause mortality and renal outcomes, (ESRD, incidence of eGFR <45 ml/min/1.73m², and eGFR slopes <-3.0 ml/min/1.73m²) in a national cohort of 957,587 US veterans with baseline estimated eGFR >60 ml/min/1.73m². Associations were examined in Cox proportional hazards models and logistic regressions. Besides crude models (model 1), adjustments were made for demographics and baseline estimated GFR (model 2), BMI and blood pressure (Model 3), comorbidities, antihypertensive drugs, and social-economic status (Model 4).

Results

41,928 patients (4.4%) had chronic insomnia. Over a 6.1-year median follow-up period, 23.1% of patients died [mortality rate: 39.4/1000 patient-years (PY)], 0.2% reached ESRD (event rate: 0.2/1000PY), 6.6% of them progressed to eGFR <45 (event rate: 11.6/1000PY), and 2.7% displayed rapid progression. Insomnia was associated with higher risk of all-cause mortality (hazard ratio (HR):1.43 [95%CI:1.37, 1.48], p<0.001), incidence of eGFR <45ml/min/1.73m² (HR: 2.51 [95%CI:2.39, 2.64], p<0.001), ESRD (HR: 2.41 [95%CI:1.66, 3.48], p<0.001), and rapid loss of kidney function (odds ratio: 1.46[95%CI: 1.33, 1.62], p<0.001) [Figure].

Conclusion

Chronic insomnia is associated with higher risk of all-cause mortality, incident CKD and progressive loss of kidney function. Further studies are needed to determine if interventions to alleviate insomnia could improve clinical outcomes.

Funding

• NIDDK Support