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Association of Chronic Insomnia With Mortality and Adverse Renal Outcomes

  • Jun Ling Lu
    Division of Nephrology, University of Tennessee Health Science Center, Memphis
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  • Amado X. Freire
    Division of Pulmonary, Critical Care and Sleep Medicine, University of Tennessee Health Science Center, Memphis

    Pulmonary Section, Memphis VA Medical Center, Memphis, TN
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  • Miklos Z. Molnar
    Division of Nephrology, University of Tennessee Health Science Center, Memphis

    Division of Transplant Surgery, Department of Surgery, University of Tennessee Health Science Center, Memphis

    Division of Transplant Surgery, Methodist University Hospital Transplant Institute, Memphis, TN

    Department of Transplantation and Surgery, Semmelweis University, Budapest, Hungary
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  • Kamyar Kalantar-Zadeh
    Harold Simmons Center for Chronic Disease Research and Epidemiology, Division of Nephrology and Hypertension, University of California, Irvine Medical Center, Orange
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  • Csaba P. Kovesdy
    Correspondence: Address to Csaba P. Kovesdy, MD, Nephrology Section, Memphis VA Medical Center, 1030 Jefferson Ave, Memphis, TN 38104.
    Division of Nephrology, University of Tennessee Health Science Center, Memphis

    Nephrology Section, Memphis VA Medical Center, Memphis, TN
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      To examine whether chronic insomnia is associated with an increased risk of adverse renal outcomes and all-cause mortality.

      Patients and Methods

      We examined associations of chronic insomnia (defined as the presence of both International Classification of Diseases, Ninth Revision codes 307.42, 307.49, and 780.52 and long-term use of insomnia medications) with adverse renal outcomes (end-stage renal disease, incidence of estimated glomerular filtration rate [eGFR] ≤45 mL/min per 1.73 m2, and eGFR slopes <−3.0 mL/min per 1.73 m2 per year) and all-cause mortality in a national cohort of 1,639,090 US veterans by using Cox proportional hazards and logistic regression models with multivariable adjustments.


      A total of 36,741 patients (2.24%) had chronic insomnia; 32,985 (89.8%) were male and 28,090 (76.5%) were white, with a mean baseline eGFR of 84.1±16.4 mL/min per 1.73 m2. Chronic insomnia was associated with a significantly higher risk of eGFR 45 mL/min per 1.73 m2 or less (multivariable-adjusted hazard ratio [HR], 1.39; 95% CI, 1.34-1.44; P<.001), and rapid loss of kidney function (odds ratio, 1.07; 95% CI, 1.03-1.12; P=.002), but not end-stage renal disease (HR, 1.25; 95% CI, 0.81-1.93; P=.32). Chronic insomnia was not associated with a higher risk of all-cause mortality (HR, 1.00; 95% CI, 0.97-1.03; P=.99).


      Chronic insomnia is associated with a higher risk of development and progression of chronic kidney disease, but not ESRD. Further studies are needed to establish the underlying mechanisms of action and to determine whether treatment of insomnia could be beneficial to prevent deteriorating kidney function.

      Abbreviations and Acronyms:

      BMI (body mass index), CKD (chronic kidney disease), eGFR (estimated glomerular filtration rate), ESRD (end-stage renal disease), ICD-9 (International Classification of Diseases, Ninth Revision), ICSD-3 (International Classification of Sleep Disorders-Third Edition), IQR (interquartile range), PY (patient-year), RCAV (Racial and Cardiovascular Risk Anomalies in Chronic Kidney Disease), VA (Veterans Affairs)
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      Linked Article

      • The Insomniac's Kidney—A Novel Perspective on Renal Dysfunction
        Mayo Clinic ProceedingsVol. 93Issue 11
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          Insomnia is the most common sleep complaint, with 6% to 10% of the adult population fulfilling diagnostic criteria for insomnia disorder.1 Nocturnal sleep difficulties produce functional consequences during the daytime, such as impaired cognitive performance, fatigue, or mood disturbances, which contribute to make insomnia a debilitating condition with considerable personal and societal costs. Furthermore, by disrupting sleep, insomnia not only erodes psychological well-being and daily functioning but may also compromise somatic health.
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