Chronic Kidney Disease, Obstructive Sleep Apnea
Conditions
Keywords
chronic kidney disease, acute kidney injury, obstructive sleep apnea
Brief summary
Obstructive sleep apnea (OSA) is a common and undertreated condition in patients with chronic kidney disease (CKD). Both physiologic and empiric data suggest that renal hypoxia due to OSA is associated with worsening kidney function. Hospitalized patients are often exposed to multiple nephrotoxins such as antibiotics, contrast agents, and diuretics, which place them at risk for acute worsening of kidney function. This study aims to determine whether immediate diagnosis and treatment of OSA in CKD patients will decrease the incidence of acute kidney injury during hospitalization. The investigators will evaluate the extent to which this effect can be attributed to a decrease in nocturnal hypoxia and improved blood pressure control. Secondary endpoints include hospital length of stay, and a composite outcome comprised of hemodialysis initiation, major cardiovascular events, and mortality.
Interventions
DEVICECPAP/autopap
Sponsors
University of South Florida
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
PREVENTION
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
19 Years to No maximum
Healthy volunteers
No
Inclusion criteria
1. CKD defined by National Kidney Foundation Staging system: eGFR \< 60 2. Overnight sleep study consistent with OSA
Exclusion criteria
1. Currently treated with positive airway pressure for sleep-disordered breathing 2. Hemodynamically unstable, defined as SBP \< 90, or use of vasopressors 3. Intubated or mechanically ventilated 4. Respiratory insufficiency, defined as P/F ratio \< 250, or requiring mechanical ventilation 5. End stage renal disease on renal replacement therapy 6. Contraindication to CPAP, including active emesis, recent intracranial surgery, altered level of consciousness
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Incidence of acute kidney injury | participants will be followed for the duration of hospital stay, an expected average of 5 days | incidence of acute kidney injury during hospitalization (defined as an increase in creatinine by 0.5 mg/dl or more) |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Nocturnal hypoxia | participants will be followed for the duration of hospital stay, an expected average of 5 days | Nocturnal hypoxia, defined as oxygen saturation \< 88% |
| Blood pressure control | participants will be followed for the duration of hospital stay, an expected average of 5 days | Blood pressure control, defined as incidence of SBP \> 160 |
| Hospital length of stay | participants will be followed for the duration of hospital stay, an expected average of 5 days | Hospital length of stay |
| composite outcome | participants will be followed for the duration of hospital stay, an expected average of 5 days | Composite outcome of a) Incidence of major cardiovascular event (acute coronary syndrome, major arrhythmia, or exacerbation of CHF), b) Initiation of hemodialysis c)In-hospital mortality |
Countries
United States
Outcome results
None listed