Advances in Clinical and Experimental Medicine

Title abbreviation: Adv Clin Exp Med
5-Year IF – 2.0, IF – 1.9, JCI (2024) – 0.43
Scopus CiteScore – 4.3
Q1 in SJR 2024, SJR score – 0.598, H-index: 49 (SJR)
ICV – 161.00; MNiSW – 70 pts
Initial editorial assessment and first decision within 24 h

ISSN 1899–5276 (print), ISSN 2451-2680 (online)
Periodicity – monthly

Download original text (EN)

Advances in Clinical and Experimental Medicine

2020, vol. 29, nr 9, September, p. 1065–1072

doi: 10.17219/acem/123356

Publication type: original article

Language: English

License: Creative Commons Attribution 3.0 Unported (CC BY 3.0)

Download citation:

  • BIBTEX (JabRef, Mendeley)
  • RIS (Papers, Reference Manager, RefWorks, Zotero)

The pattern of overnight changes in novel markers of acute kidney injury in patients with obstructive sleep apnea

Michał Nowicki1,A,B,C,D,E,F, Anna Zawiasa-Bryszewska1,A,B,C,D, Małgorzata Taczykowska1,B, Piotr Białasiewicz2,A,B,C,E, Dariusz Nowak2,A,C,E,F

1 Department of Nephrology, Hypertension and Kidney Transplantation, Medical University of Lodz, Poland

2 Chair of Physiology, Medical University of Lodz, Poland

Abstract

Background. Obstructive sleep apnea (OSA) may predispose patients to acute kidney injury (AKI) and chronic kidney disease (CKD).
Objectives. We postulated that apneic episodes during sleep in patients with OSA may result in episodes of subclinical AKI that may be detected by the use of novel sensitive serum and urine markers. The treatment of OSA may protect against renal injury.
Material and Methods. The study involved 86 men who had positive screening test results for OSA and estimated glomerular filtration rates (eGFR) calculated with the Chronic Kidney Disease Epidemiology Collaboration (CDK-EPI) equation >60 mL/min/1.73 m². All the patients underwent overnight polysomnography (the diagnostic night). The patients were divided into 2 groups: 45 patients with mild OSA and 41 patients with moderate-to-severe OSA. Those in the latter group were qualified for 6–8 weeks of continuous positive airway pressure (CPAP) treatment. Blood pressure, serum creatinine, high sensitivity C-reactive protein (hsCRP), urine creatinine, AKI markers cystatin C and neutrophil gelatinase-associated lipocalin (NGAL), kidney injury molecule 1 (KIM-1), liver-type fatty acid-binding protein, and endothelium marker intercellular adhesion molecule-1 (ICAM-1) were assessed in both groups before and after polysomnography. The same parameters were also measured in the patients with moderate-to-severe OSA after CPAP therapy.
Results. Kidney injury molecule 1 and urine NGAL significantly increased after the diagnostic night in the whole group and in mild OSA patients (p = 0.04 and p = 0.001, respectively). Serum ICAM-1 significantly decreased after the diagnostic night only in mild OSA patients (p = 0.03. Urine cystatin C increased after 6–8 weeks of CPAP treatment in the moderate-to-severe OSA group (0.003). Serum ICAM-1 decreased after the CPAP treatment (p = 0.02). The CPAP therapy led also to a decrease in mean and diastolic (p = 0.005) blood pressure.
Conclusion. The pattern of overnight changes in serum and urine AKI markers after apneic episodes during sleep may suggest an increased risk of subclinical AKI in patients with OSA. The CPAP therapy is not protective against AKI, but may reduce some of its risk factors, including high blood pressure and endothelial damage.

Key words

biomarkers, acute kidney injury, obstructive sleep apnea, NGAL

References (36)

  1. Gonzaga C, Bertolami A, Bertolami M, Amodeo C, Calhoun D. Obstructive sleep apnea, hypertension and cardiovascular diseases. J Hum Hypertens. 2015;29(12):705–712.
  2. Foster GE, Poulin MJ, Hanly PJ. Intermittent hypoxia and vascular function: Implications for obstructive sleep apnoea. Exp Physiol. 2007;92(1):51–65.
  3. Domenech P, Perez T, Saldarini A. Uad P, Musso CG. Kidney-lung pathophysiological crosstalk: Its characteristics and importance. Int Urol Nephrol. 2017;49(7):1211–1215.
  4. Dou L, Lan H, Reynolds DJ, et al. Association between obstructive sleep apnea and acute kidney injury in critically ill patients: A propensity-matched study. Nephron. 2017;135(2):137–146.
  5. Tsioufis C, Thomopoulos C, Dimitriadis K, et al. Association of obstructive sleep apnea with urinary albumin excretion in essential hypertension: A cross-sectional study. Am J Kidney Dis. 2008;52(2):285–293.
  6. Agrawal V, Vanhecke TE, Rai B, Franklin BA, Sangal RB, McCullough PA. Albuminuria and renal function in obese adults evaluated for obstructive sleep apnea. Nephron Clin Pract. 2009;113(3):c140–c147.
  7. Kashani K, Cheungpasitporn W, Ronco C. Biomarkers of acute kidney injury: The pathway from discovery to clinical adoption. Clin Chem Lab Med. 2017;55(8):1074–1089.
  8. Vanmassenhove J, Vanholder R, Nagler E, Van Biesen W. Urinary and serum biomarkers for the diagnosis of acute kidney injury: An in-depth review of the literature. Nephrol Dial Transplant. 2013;28(2):254–273.
  9. Lattimore JL, Wilcox I, Skilton M, Langenfeld M, Celermajer DS. Treatment of obstructive sleep apnoea leads to improved microvascular endothelial function in the systemic circulation. Thorax. 2006;61(6):491–495.
  10. Pépin JL, Tamisier R, Baguet JP, Lévy P. Arterial health is related to obstructive sleep apnea severity and improves with CPAP treatment. Sleep Med Rev. 2013;17(1):3–5.
  11. Kinebuchi S, Kazama JJ, Satoh M, et al. Short-term use of continuous positive airway pressure ameliorates glomerular hyperfiltration in patients with obstructive sleep apnoea syndrome. Clin Sci (Lond). 2004;107(3):317–322.
  12. Berry RB, Budhiraja R, Gottlieb DJ, et al; American Academy of Sleep Medicine. Rules for scoring respiratory events in sleep: Update of the 2007 AASM Manual for the Scoring of Sleep and Associated Events. Deliberations of the Sleep Apnea Definitions Task Force of the American Academy of Sleep Medicine. J Clin Sleep Med. 2012;8(5):597–619.
  13. Koga S, Ikeda S, Yasunaga T, Nakata T, Maemura K. Effects of nasal continuous positive airway pressure on the glomerular filtration rate in patients with obstructive sleep apnea syndrome. Intern Med. 2013;52(3):345–349.
  14. Faulx MD, Storfer-Isser A, Kirchner HL, Jenny NS, Tracy RP, Redline S. Obstructive sleep apnea is associated with increased urinary albumin excretion. Sleep. 2007;30(7):923–929.
  15. Chuang LP, Lin SW, Lee LA, et al. Elevated serum markers of acute kidney injury in patients with obstructive sleep apnea. J Clin Sleep Med. 2019;15(2):207–213.
  16. Soto K, Coelho S, Rodrigues B, et al. Cystatin C as a marker of acute kidney injury in the emergency department. Clin J Am Soc Nephrol. 2010;5(10):1745–1754.
  17. Bennett M, Dent CL, Ma Q, et al. Urine NGAL predicts severity of acute kidney injury after cardiac surgery: A prospective study. Clin J Am Soc Nephrol. 2008;3(3):665–673.
  18. Huang Y, Don-Wauchope AC. The clinical utility of kidney injury molecule 1 in the prediction, diagnosis and prognosis of acute kidney injury: A systematic review. Inflamm Allergy Drug Targets. 2011;10(4):260–271.
  19. Shao X, Tian L, Xu W, et al. Diagnostic value of urinary kidney injury molecule 1 for acute kidney injury: A meta-analysis. PLoS One. 2014;9(1):e84131.
  20. McIlroy DR, Wagener G, Lee HT. Neutrophil gelatinase-associated lipocalin and acute kidney injury after cardiac surgery: The effect of baseline renal function on diagnostic performance. Clin J Am Soc Nephrol. 2010;5(2):211–219.
  21. Murase K, Mori K, Yoshimura C, et al. Association between plasma neutrophil gelatinase associated lipocalin level and obstructive sleep apnea or nocturnal intermittent hypoxia. PLoS One. 2013;8(1):e54184.
  22. Zhang XB, Lin QC, Deng CS, Chen GP, Cai ZM, Chen H. Elevated serum cystatin C in severe OSA younger men without complications. Sleep Breath. 2013;17(1):235–241.
  23. Zhang XB, Jiang XT, Lin QC, Chen X, Zeng HQ. Effect of continuous positive airway pressure on serum cystatin C among obstructive sleep apnea syndrome patients. Int Urol Nephrol. 2014;46(10):1997–2002.
  24. Kato K, Takata Y, Usui Y, et al. Severe obstructive sleep apnea increases cystatin C in clinically latent renal dysfunction. Respir Med. 2011;105(4):643–649.
  25. Ohga E, Nagase T, Tomita T, et al. Increased levels of circulating ICAM-1, VCAM-1 and L-selectin in obstructive sleep apnea syndrome. J Appl Physiol (1985). 1999;87(1):10–14.
  26. El-Solh AA, Mador MJ, Sikka P, Dhillon RS, Amsterdam D, Grant BJ. Adhesion molecules in patients with coronary artery disease and moderate-to-severe obstructive sleep apnea. Chest. 2002;121(5):1541–1547.
  27. Zamarron-Sanz C, Ricoy-Galbaldon J, Gude-Sampedro F, Riveiro-Riveiro A. Plasma levels of vascular endothelial markers in obstructive sleep apnea. Arch Med Res. 2006;37(4):552–555.
  28. Ursavaş A, Karadağ M, Rodoplu E, Yilmaztepe A, Oral HB, Gözü RO. Circulating ICAM-1 and VCAM-1 levels in patients with obstructive sleep apnea syndrome. Respiration. 2007;74(5):525–532.
  29. Ohga E, Tomita T, Wada H, Yamamoto H, Nagase T, Ouchi Y. Effects of obstructive sleep apnea on circulating ICAM-1, IL-8 and MCP-1. J Appl Physiol (1985). 2003;94(1):179–184.
  30. Chin K, Nakamura T, Shimizu K, et al. Effects of nasal continuous positive airway pressure on soluble cell adhesion molecules in patients with obstructive sleep apnea syndrome. Am J Med. 2000;109(7):562–567.
  31. Wang YN, Yang Y, Luo YQ, Chen LL. Effects of nasal continuous positive airway pressure short-term treatment on C-reactive protein and intercellular adhesion molecule-1 in patients with obstructive sleep apnea-hypopnea syndrome [in Chinese]. Zhong Nan Da Xue Xue Bao Yi Xue Ban. 2005;30:666–669.
  32. Li K, Wei P, Qin Y, Wei Y. Is C-reactive protein a marker of obstructive sleep apnea? A meta-analysis. Medicine (Baltimore). 2017;96(19):e6850.
  33. Martínez-García MA, Capote F, Campos-Rodríguez F, et al. Effect of CPAP on blood pressure in patients with obstructive sleep apnea and resistant hypertension: The HIPARCO randomized clinical trial. JAMA. 2013;310(22):2407–2415.
  34. Durán-Cantolla J, Aizpuru F, Montserrat JM, et al. Continuous positive airway pressure as treatment for systemic hypertension in people with obstructive sleep apnoea: Randomised controlled trial. BMJ. 2010;341:c5991.
  35. Muxfeldt ES, Margallo V, Costa LM, et al. Effects of continuous positive airway pressure treatment on clinic and ambulatory blood pressures in patients with obstructive sleep apnea and resistant hypertension: A randomized controlled trial. Hypertension. 2015;65(4):736–742.
  36. Cullen MR, Murray PT, Fitzgibbon MC. Establishment of a reference interval for urinary neutrophil gelatinase-associated lipocalin. Ann Clin Biochem. 2012;49(Pt 2):190–193.
© Wroclaw Medical University