Obstructive sleep apnea as a risk factor for incident end stage renal disease: a nationwide population-based cohort study from Korea (original) (raw)

Abstract

Background

Obstructive sleep apnea (OSA) is known to be associated with metabolic dysregulation and incident cardiovascular diseases. However, its association with end-stage renal disease (ESRD) has not been clarified. This study aimed to evaluate longitudinally whether OSA is an independent risk factor for ESRD.

Methods

This retrospective nationwide population-based cohort study included data on 67,359 patients with OSA and 336,795 age-, sex- and years of the enrollment-matched controls without OSA obtained from the Korean National Health Insurance Service database from 2009 to 2014. The study population was followed up from baseline to the date of ESRD diagnosis or until 2016. A Cox proportional-hazards model with multivariable adjustment was used to evaluate the association between OSA and incident ESRD.

Results

A significantly higher incident ESRD risk (adjusted hazard ratio: 1.29, 95% confidence interval 1.02–1.62) was observed for patients older than 40 years with OSA than for matched controls, when adjusted for age, sex, income status, smoking, alcohol consumption, body mass index, diabetes, hypertension, dyslipidemia, estimated glomerular filtration rate, and proteinuria. The OSA group remained predictive of higher risk of ESRD incidence in subgroups of age ≥ 65 years, female sex, hypertension, dyslipidemia, proteinuria, and chronic kidney disease.

Conclusion

OSA was associated with a higher risk of incident ESRD. Understanding the association between OSA and ESRD might provide further insights to establish national health care policy.

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Acknowledgements

This study was supported by the Bio & Medical Technology Development Program of the NRF funded by the Korean government, MSIT (NRF-2017M3A9E8023016, NRF-2017M3A9E8023001); Grant (BCRI18024) of Chonnam National University Hospital Biomedical Research Institute; and Grant (CRI18015-1) of Chonnam National University Hospital Biomedical Research Institute.

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Author notes

  1. Hong Sang Choi and Ha Yeon Kim contributed equally

Authors and Affiliations

  1. Department of Internal Medicine, Chonnam National University Medical School, 42 Jebongro, Gwangju, 61469, Korea
    Hong Sang Choi, Ha Yeon Kim, Chang Seong Kim, Eun Hui Bae, Seong Kwon Ma & Soo Wan Kim
  2. Department of Medical Statistics, College of Medicine, The Catholic University of Korea, Seoul, Korea
    Kyung-Do Han & Jin-Hyung Jung

Authors

  1. Hong Sang Choi
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  2. Ha Yeon Kim
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  3. Kyung-Do Han
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  4. Jin-Hyung Jung
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  5. Chang Seong Kim
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  6. Eun Hui Bae
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  7. Seong Kwon Ma
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  8. Soo Wan Kim
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Correspondence toSoo Wan Kim.

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Ethical approval was waived in this study by the Institutional Review Board (IRB) of Chonnam National University Hospital (#IRB no. CNUH-EXP-2018-019).

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Choi, H.S., Kim, H.Y., Han, KD. et al. Obstructive sleep apnea as a risk factor for incident end stage renal disease: a nationwide population-based cohort study from Korea.Clin Exp Nephrol 23, 1391–1397 (2019). https://doi.org/10.1007/s10157-019-01779-6

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