• Alex N Rimke, Sofia B Ahmed, Tanvir C Turin, Sachin R Pendharkar, Jill K Raneri, Emma J Lynch, and Patrick J Hanly.
• Sleep Centre, Foothills Medical Centre, University of Calgary, Calgary, AB, Canada; Libin Cardiovascular Institute of Alberta, Calgary, AB, Canada.
• Chest. 2021 May 1; 159 (5): 2008-2019.

BackgroundOSA is common in chronic kidney disease (CKD) and may accelerate a decline in kidney function. It is not clear whether treatment of OSA with CPAP improves kidney function.Research QuestionDoes treatment with CPAP improve kidney function in patients with CKD and coexisting OSA?Study Design And MethodsA randomized, controlled, nonblinded, parallel clinical trial was performed of patients with stages 3 and 4 CKD and coexisting OSA comparing the effect of CPAP vs usual care on the estimated glomerular filtration rate (eGFR) and the urine albumin to creatinine ratio (ACR) over 12 months.ResultsFifty-seven patients were enrolled and 30 were randomized to CPAP. They had moderately severe CKD (eGFR, 38.4 ± 1.5 mL/min/1.73 m2) and significant OSA and nocturnal hypoxemia (oxygen desaturation index: 23.9 events/h; interquartile range [IQR], 20.3 events/h; mean peripheral capillary oxygen saturation: 89.5%; IQR, 1.7%); 60% had baseline albuminuria (ACR, > 3 mg/mmol). No significant difference was found between CPAP and usual care in the change in eGFR and ACR over 12 months. Although some improvement in eGFR occurred with CPAP therapy in patients with a lower risk of CKD progression, this did not reach statistical significance.InterpretationAlthough CPAP did not provide additional renal benefits over usual care in all CKD patients, some evidence suggested that CPAP slowed the decline in eGFR in CKD patients with a lower risk of CKD progression. These preliminary data support the need for larger clinical trials exploring the effects of CPAP on kidney function.Trial RegistryClinicalTrials.gov; No.: NCT02420184; URL: www.clinicaltrials.gov.Copyright © 2020 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.

3 keywords...

hide…