Effect of CPAP Therapy on Kidney Function in Patients With Chronic Kidney Disease

Rimke, Alex N.; Ahmed, Sofia B.; Turin, Tanvir Chowdhury; Pendharkar, Sachin R.; Raneri, Jill K.; Lynch, Emma; Hanly, Patrick J.

doi:10.1016/j.chest.2020.11.052

Cited by 24 publications

(12 citation statements)

References 48 publications

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“…In our paper, we mentioned the apparent discrepancy between our results and those obtained in a previous clinical trial, which did not demonstrate improved renal function after CPAP ( 2 ). We reiterate that in our opinion, the two studies are not comparable, as Rimke and colleagues ( 2 ) selected patients with more severe kidney disease (estimated glomerular filtration rate 39.4 vs. 61 ml/min/1.73 m 2 ), and only a small percentage had diabetes. In fact, only 30% of the patients assigned to the CPAP group and 19% of those assigned to the control group had previous diagnoses of DKD.…”

contrasting

confidence: 99%

Reply to Chen et al.

Zamarrón

García‐Río

2023

Am J Respir Crit Care Med

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contrasting

confidence: 99%

Reply to Chen et al.

Zamarrón

García‐Río

2023

Am J Respir Crit Care Med

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“…Obstructive sleep apnea can also contribute to CKD (Ahmed et al, 2011), and possible mechanisms include hypertension and intra‐renal hypoxaemia with glomerular hyperfiltration (Abuyassin et al, 2015). However, retrospective data analysis from the Wisconsin Sleep Cohort reported that OSA did not accelerate kidney function decline over time (Canales et al, 2018) and long‐term follow‐up of CPAP therapy in patients with OSA have shown no sustained benefit to renal function (Loffler et al, 2017; Rimke et al, 2021).…”

Section: Comorbiditiesmentioning

confidence: 99%

Obstructive sleep apnea: transition from pathophysiology to an integrative disease model

McNicholas

Pevernagie

2022

Journal of Sleep Research

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Summary Obstructive sleep apnea (OSA) is characterised by recurring episodes of upper airway obstruction during sleep and the fundamental abnormality reflects the inability of the upper airway dilating muscles to withstand the negative forces generated within the upper airway during inspiration. Factors that result in narrowing of the oropharynx such as abnormal craniofacial anatomy, soft tissue accumulation in the neck, and rostral fluid shift in the recumbent position increase the collapsing forces within the airway. The counteracting forces of upper airway dilating muscles, especially the genioglossus, are negatively influenced by sleep onset, inadequacy of the genioglossus responsiveness, ventilatory instability, especially post arousal, and loop gain. OSA is frequently associated with comorbidities that include metabolic, cardiovascular, renal, pulmonary, and neuropsychiatric, and there is growing evidence of bidirectional relationships between OSA and comorbidity, especially for heart failure, metabolic syndrome, and stroke. A detailed understanding of the complex pathophysiology of OSA encourages the development of therapies targeted at pathophysiological endotypes and facilitates a move towards precision medicine as a potential alternative to continuous positive airway pressure therapy in selected patients.

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“…The native highlanders here suffered from hypoxia all years around. Accumulating studies had demonstrated that hypoxia was directly related to the development of kidney injury symptoms, such as the elevation of blood creatinine and urea, hematuria, proteinuria as well as cytokines and cytokine storms [28][29][30]. Respiratory syndrome coronavirus 2 (SARS-CoV-2) caused body oxygen de ciency due to lung damages, leading to 5-23% of patients diagnosed with AKI in hospital and 68% in ICU [31,32].…”

Section: Discussionmentioning

confidence: 99%

The Benefits of Early Continuous Renal Replacement Therapy in Critically Ill Patients with Acute Kidney Injury at High-Altitude Areas: A Retrospective Multi-center Cohort Study

Wang

Peng

Wei

et al. 2023

Preprint

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Severe hypoxia would aggravate the acute kidney injure (AKI) in high-altitude areas and continuous renal replacement therapy (CRRT) has been used to treat critically ill patients with AKI. However, the characteristics and outcomes of CRRT of critically ill patients with AKI in high altitude and the optimal timing of CRRT initiation are still unclear. 1,124 patients were diagnosed with AKI and treated with CRRT in ICU, involving high-altitude group (n = 648) and low-altitude group (n = 476). Compared with low-altitude group, patients with AKI in high altitude showed longer CRRT (4.8 vs. 3.7, P = 0.036) and more rapid progression of AKI stages (P < 0.01), but without any significance of minor or major bleeding episode (P > 0.05). Referring to the analysis of survival and kidney recovery curves, a higher mortality but a lower possibility of renal recovery was observed in high-altitude group (P < 0.001). However, in the high-altitude group, the survival rate of early CRRT initiation was significantly higher than that of delayed CRRT initiation (P < 0.001). The findings showed poorer clinical outcomes of patients undergoing CRRT for AKI in high altitude. CRRT at high altitude was unlikely to increase the adverse events. Moreover, early CRRT initiation might reduce the mortality and promote renal recovery in high-altitude patients.

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Effect of CPAP Therapy on Kidney Function in Patients With Chronic Kidney Disease

Cited by 24 publications

References 48 publications

Reply to Chen et al.

Reply to Chen et al.

Obstructive sleep apnea: transition from pathophysiology to an integrative disease model

The Benefits of Early Continuous Renal Replacement Therapy in Critically Ill Patients with Acute Kidney Injury at High-Altitude Areas: A Retrospective Multi-center Cohort Study

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