Effects of hemodialysis on upper airways collapsibility in patients with chronic kidney disease
Santos, Israel Reis; Danaga, Aline Roberta; Silva, Anderson Soares; Urbano, Jessica Julioti; Oliveira, Ezequiel Fernandes; Peixoto, Roger Andre de Oliveira; Guimarães, Letícia Lopes; Oliveira, Patrícia Clemente; Queiroz, Bruno Carlos de; Gonçalves, Caroline de Freitas; Tomei, Jéssica Scheurs; Perez, Eduardo Araujo; Nacif, Sergio R.; Souza, Fatima Maria Leite de; Martin, Luis Cuadrado; Oliveira, Luis Vicente Franco
Abstract
Introduction: The Chronic Kidney Disease (CKD) is characterized as a clinical condition wherein the progressive loss of renal function for a period longer than months to years will lead to the onset of end-stage renal disease (ESRD). In the advanced stages of CKD, patients can only be treated with replacement therapy, dialysis or transplantation. In this context, hemodialysis (HD) presents as the main treatment option for these patients due to the lack of donors. Patients with ESRD in HD often present signs and symptoms related to pre-existing or acquired comorbidities with worsening of the disease. The most frequent are electrolytic disturbances, anemia, malnutrition, bone disease, Melittus diabetes, systemic arterial hypertension, gastrointestinal disorders, respiratory disorders, cardiovascular diseases, neurological changes and sleep disorders. Obstructive sleep apnea (OSA) presents a tenfold prevalence in patients with ESRD when compared to the general population, worsening the clinical symptoms and cardiovascular complications of this disease. The increase in the number of ESRD patients submitted to HD has assumed epidemic proportions worldwide. The causal association between sleep-disordered breathing, in particular OSA and ESRD, is still not well understood, which expands the possibility of new findings for the prevention, diagnosis and treatment of OSA, improving quality of life and reducing morbimortality. Objective: The present study involving ESRD patients undergone HD was designed with three main objectives: 1) to verify the prevalence and severity of sleep-disordered breathing; 2) to analyze the behavior of sleep apnea / hypopnea index (AHI) during the interdialitic period; 3) to verify weight gain and anthropometric measurements during the interdialitic period. Method: A consecutive single-center cross-sectional clinical study will be performed, double-blind, non-randomized to investigate the behavior of AHI in patients with ESRD undergoing HD in the nephrology unit (UNEFRO) at the Hospital of Santa Casa de Misericordia de Avaré, (SP), Brazil. The design and conduct of this study followed the guidelines of the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement
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References
1- Kalamas AG, Niemann CU Patients with Chronic Kidney Disease. Med Clin N Am 2013;97:1109–1122.
2- Coresh J, Byrd-Holt D, Astor BC, Briggs JP, Eggers PW, Lacher DA, et al. Chronic Kidney Disease Awareness, Prevalence, and Trends among U.S. Adults, 1999 to 2000. J Am Soc Nephrol 2005;16:180 –188.
3- Zoccali C, Kramer A, Jager KJ. Epidemiology of CKD in Europe: an uncertain scenario. Nephrol Dial Transplant 2010;25:1731–1733.
4- Abbasi M, Chertow GM, Hall YN. End-stage renal disease. BMJ Clinical Evidence 2010;07:2002.
5- Sesso, RC, Lopes AA, Thomé FS, Lugon Jr, Watanabe Y, Santos Dr. Chronic dialysis in Brazil: report of the Brazilian dialysis census, 2011. J Bras Nefrol 2012;34(3):272-7.
6- Jurkovitz CT, Elliott D, Li S, Saab G, Bomback AS, Norris KC, et al. Physician utilization, risk-factor control, and CKD progression among participants in the Kidney Early Evaluation Program (KEEP). Am J Kidney Dis 2012;59(2):S24-33.
7- Nieto FJ, Young TB, Lind BK, Shahar E, Samet JM, Redline S, et al. Association of sleep-disordered breathing, sleep apnea and hypertension in a large community-based study. Sleep Heart Health Study. JAMA 2000;12(14):1829-1836.
8- Drager LF, Bortolotto LA, Krieger EM, Lorenzi-Filho G. Additive Effects of Obstructive Sleep Apnea and Hypertension on Early Markers of Carotid Atherosclerosis. Hypertension 2009;53(1):64-69.
9- Mclntyre CW, Selby NM, Sigrist M, Pearce LE, Mercer TH, Naish PF. Patients receiving maintenance dialysis have more severe functionally significant skeletal muscle wasting than patients with dialysis-independent chronic kidney disease. Nephrol Dial Transplant 2006;21(8):2210–2216.
10- London GM. Cardiovascular Disease in Chronic Renal Failure: Pathophysiologic Aspects. Semin Dial 2003;16(2):85-94.
11- Weiner DE, Tighiouart H, Stark PC, Amin MG, Macleod B, Griffith JL, et al. Kidney Disease as a Risk Factor for Recurrent Cardiovascular Disease and Mortality. Am J Kidney Dis. v.44, n.2, p.198-206, 2004.
12- Zoccali C, Mallamaci F, Tripepi G. Novel Cardiovascular Risk Factors in End-Stage Renal Disease. J Am Soc Nephrol 2004;15(Suppl 1):S77–S80.
13- Brouns R, De Deyn P. Neurological complications in renal failure: a review. Clin Neurol Neurosurg. 2004;107(1):1-16.
14- Turek NF, Ricardo AC, Lash JP. Sleep disturbances as nontraditional risk factors for development and progression of CKD: review of the evidence. Am J Kidney Dis. 2012;60(5):823-33.
15- Hamdan Al-Jahdali. Prevalence of Sleep Apnea and Excessive Day Time Sleepiness in Patients with End-Stage Renal Disease on Dialysis. Saudi J Kidney Dis Transpl 2012;23(2):251-261.
16- Merlino G, Piani A, Dolso P, Adorati M, Cancelli I, Valente M, Gigli GL. Sleep disorders in patients with end-stage renal disease undergoing dialysis therapy. Nephrol Dial Transplant 2006;21:184–190.
17- Unruh ML, Sanders MH, Redline S. Sleep Apnea in Patients on Conventional Thrice-Weekly Hemodialysis: Comparison with Matched Controls from the Sleep Heart Health Study. J Am Soc Nephrol 2006;17:3503–3509.
18- Ogna VF, Ogna A, Pruijm M, Bassi I, Zuercher E, Halabi G, et al. Prevalence and Diagnostic Approach to Sleep Apnea in Hemodialysis Patients: A Population Study. Biomed Res Int. 2015;2015:103686.
19- Wali SO, Alkhouli A, Howladar M, Ahmad I, Alshohaib S, Al-Ghamdi S, et al. Risk of obstructive sleep apnea among Saudis with chronic renal failure on hemodialysis. Ann Thorac Med. 2015 Oct-Dec;10(4):263-8.
20- Sleep-related breathing disorders in adults: Recommendations for syndrome definition and measurement techniques in clinical research. The Report of an American Academy of Sleep Medicine Task Force. SLEEP, 1999, 22, 5,667-89.
21- Javaheri S, Parker TJ, Wexler L, Michaels SE, Stanberry E, Nishyama H, et al. Occult sleep-disordered breathing in stable congestive heart failure. Ann Intern Med. 1995;122(7):487-492.
22- Javaheri S, Parker TJ, Liming JD, Corbett WS, Nishiyama H, Wexler L, et al. Sleep apnea in 81 ambulatory male patients with stable heart failure. Types and their prevalences, consequences, and presentations. Circulation. 1998 ;97(21):2154–2159.
23- Shahar E, Whitney CW, Redline S, Lee ET, Newman AB, Nieto FJ, et al. Sleep-disordered breathing and cardiovascular disease: cross-sectional results of the Sleep Heart Health Study. Am J Respir Crit Care Med. 2001;163(1):19-25.
24- Redolfi S, Yumino D, Ruttanaumpawan P, Yau B, Su MC, Lam J, et al. Relationship between overnight rostral fl uid shift and Obstructive Sleep Apnea in nonobese men. Am J Respir Crit Care Med. 2009;179(3):241– 246.
25- Elias RM, Bradley TD, Kasai T, Motwani SS, Chan CT et al. Rostral overnight fluid shift in end-stage renal disease: relationship with obstructive sleep apnea. Nephrol Dial Transplant 2011; 27: 1569–1573.
26- Elias RM, Chan CT, Paul N, Motwani SS, Kasai T, Gabriel JM, et al. Relationship of pharyngeal water content and jugular volume with severity of obstructive sleep apnea in renal failure. Nephrol Dial Transplant (2013) 28: 937–944.
27- Lyons OD, Chan CT, Yadollahi A, Bradley TD. Effect of Ultrafiltration on Sleep Apnea and Sleep Structure in Patients with End-Stage Renal Disease. Am J Respir Crit Care Med 2015;191(11):1287–1294.
28- Park J, Ann SH, Chung HC, Lee JS, Kim SJ, Garg S, et al. Remote ischemic preconditioning in hemodialysis: a pilot study. Heart Vessels. 2014 Jan;29(1):58-64.
29- World Health Organization. Obesity: preventing and managing the global epidemic. Report of a World Health Organization Consultation. Geneva: World Health Organization, 2000. p. 256. WHO Obesity Technical Report Series, n. 284.
30- Gabrielsen AM, Lund MB, Kongerud J, Viken KE, Roislien J, Hjelmesaeth J. The relationship between anthropometric measures, blood gases, and lung function in morbidly obese white subjects. Obes Surg 2011;21(4):485-491.
31- Collop NA, Anderson WM, Boehlecke B, Claman D, Goldberg R, Gottlieb DJ, et al. Clinical guidelines for the use of unattended portable monitors in the diagnosis of obstructive sleep apnea in adult patients. J Clin Sleep Med 2007;3(7):737-747. 32- Berry RB, Brooks R, Gamaldo CE, Harding SM, Lloyd RM, Marcus CL, et al. The AASM Manual for the Scoring of Sleep and Associated Events: Rules, Terminology and Technical Specifications, Version 2.2. www.aasmnet.org. Darien, Illinois: American Academy of Sleep Medicine, 2015.
33- Ogna A, Forni Ogna V, Mihalache A, Pruijm M, Halabi G, Phan O, et al., Obstructive Sleep Apnea Severity and Overnight Body Fluid Shift before and after Hemodialysis. Clin J Am Soc Nephrol 10: 1002–1010, 2015.
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