Nocturnal hypoxemic burden is associated with worsening prognosis of chronic kidney disease in patients with type 2 diabetes | Cardiovascular Diabetology

  • Ong KL, Stafford LK, McLaughlin SA, Boyko EJ, Vollset SE, Smith AE, et al. Global, regional, and national burden of diabetes from 1990 to 2021, with projections of prevalence to 2050: A systematic analysis for the Global Burden of Disease Study 2021. Lancet. 2023;402:203–34.

    Google Scholar 

  • Romagnani P, Agarwal R, Chan JCN, Levin A, Kalyesubula R, Karam S, et al. Chronic kidney disease. Nat Rev Dis Prim. 2025;11:8.

    PubMed 

    Google Scholar 

  • Stevens PE, Ahmed SB, Carrero JJ, Foster B, Francis A, Hall RK, et al. KDIGO 2024 clinical practice guideline for the evaluation and management of chronic kidney disease. Kidney Int. 2024;105:S117–314.

    Google Scholar 

  • Foreman KJ, Marquez N, Dolgert A, Fukutaki K, Fullman N, McGaughey M, et al. Forecasting life expectancy, years of life lost, and all-cause and cause-specific mortality for 250 causes of death: reference and alternative scenarios for 2016–40 for 195 countries and territories. Lancet. 2018;392:2052–90.

    PubMed 
    PubMed Central 

    Google Scholar 

  • KDIGO. Clinical practice guideline for diabetes management in chronic kidney disease. Kidney Int. 2022;2022(102):S1–127.

    Google Scholar 

  • Wan EYF, Chin WY, Yu EYT, Wong ICK, Chan EWY, Li SX, et al. The impact of cardiovascular disease and chronic kidney disease on life expectancy and direct medical cost in a 10-year diabetes cohort study. Diabetes Care. 2020;43:1750–8.

    PubMed 

    Google Scholar 

  • Grams ME, Coresh J, Matsushita K, Ballew SH, Sang Y, Surapaneni A, et al. Estimated glomerular filtration rate, albuminuria, and adverse outcomes: an individual-participant data meta-analysis. JAMA. 2023;330:1266–77.

    CAS 
    PubMed 
    PubMed Central 

    Google Scholar 

  • Kious KW, Savage KA, Twohey SCE, Highum AF, Philipose A, Díaz HS, et al. Chronic intermittent hypoxia promotes glomerular hyperfiltration and potentiates hypoxia-evoked decreases in renal perfusion and PO2. Front Physiol. 2023;14:1235289.

    PubMed 
    PubMed Central 

    Google Scholar 

  • O`Neill J, Jasionek G, Drummond SE, Brett O, Lucking EF, Abdulla MA, O’Halloran KD. Renal cortical oxygen tension is decreased following exposure to long-term but not short-term intermittent hypoxia in the rat. Am J Physiol Renal Physiol. 2019;316:F635–45.

    CAS 
    PubMed 

    Google Scholar 

  • Lee Y-C, Hung S-Y, Wang H-K, Lin C-W, Wang H-H, Chen S-W, et al. Sleep apnea and the risk of chronic kidney disease: a nationwide population-based cohort study. Sleep. 2015;38:213–21.

    PubMed 
    PubMed Central 

    Google Scholar 

  • Choi HS, Kim HY, Han K-D, Jung J-H, Kim CS, Bae EH, et al. Obstructive sleep apnea as a risk factor for incident end stage renal disease: a nationwide population-based cohort study from Korea. Clin Exp Nephrol. 2019;23:1391–7.

    CAS 
    PubMed 

    Google Scholar 

  • Sakaguchi Y, Hatta T, Hayashi T, Shoji T, Suzuki A, Tomida K, et al. Association of nocturnal hypoxemia with progression of CKD. Clin J Am Soc Nephrol. 2013;8:1502–7.

    CAS 
    PubMed 
    PubMed Central 

    Google Scholar 

  • Ahmed SB, Ronksley PE, Hemmelgarn BR, Tsai WH, Manns BJ, Tonelli M, et al. Nocturnal hypoxia and loss of kidney function. PLoS ONE. 2011;6: e19029.

    CAS 
    PubMed 
    PubMed Central 

    Google Scholar 

  • Dörhöfer L, Lammert A, Krane V, Gorski M, Banas B, Wanner C, et al. Study design of DIACORE (DIAbetes COhoRtE)—A cohort study of patients with diabetes mellitus type 2. BMC Med Genet. 2013;14:25.

    PubMed 
    PubMed Central 

    Google Scholar 

  • Lampert T, Kroll L, Müters S, Stolzenberg H. Messung des sozioökonomischen Status in der Studie zur Gesundheit Erwachsener in Deutschland (DEGS1) [Measurement of socioeconomic status in the German Health Interview and Examination Survey for Adults (DEGS1)]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz. 2013;56:631–6.

    CAS 
    PubMed 

    Google Scholar 

  • Erman MK, Stewart D, Einhorn D, Gordon N, Casal E. Validation of the ApneaLink for the screening of sleep apnea: a novel and simple single-channel recording device. J Clin Sleep Med. 2007;3:387–92.

    PubMed 
    PubMed Central 

    Google Scholar 

  • Stadler S, Zimmermann T, Franke F, Rheinberger M, Heid IM, Böger CA, Arzt M. Association of sleep-disordered breathing with diabetes-associated kidney disease. Ann Med. 2017;49:487–95.

    PubMed 

    Google Scholar 

  • Linz D, Malfertheiner MV, Werner N, Lerzer C, Gfüllner F, Linz B, et al. Nocturnal hypoxemic burden during positive airway pressure treatment across different central sleep apnea etiologies. Sleep Med. 2021;79:62–70.

    PubMed 

    Google Scholar 

  • Baumert M, Immanuel SA, Stone KL, Litwack Harrison S, Redline S, Mariani S, et al. Composition of nocturnal hypoxaemic burden and its prognostic value for cardiovascular mortality in older community-dwelling men. Eur Heart J. 2020;41:533–41.

    PubMed 

    Google Scholar 

  • Stone KL, Blackwell TL, Ancoli-Israel S, Barrett-Connor E, Bauer DC, Cauley JA, et al. Sleep disordered breathing and risk of stroke in older community-dwelling men. Sleep. 2016;39:531–40.

    PubMed 
    PubMed Central 

    Google Scholar 

  • Berry RB, Budhiraja R, Gottlieb DJ, Gozal D, Iber C, Kapur VK, et al. 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;8:597–619.

    PubMed 
    PubMed Central 

    Google Scholar 

  • Driendl S, Baumert M, Arzt M, Stark KJ, Pec J, Sinha F, et al. Nocturnal hypoxemic burden is associated with incident major adverse cardiovascular events in patients with type 2 diabetes. Eur J Prev Cardiol. 2025.

  • Driendl S, Stadler S, Arzt M, Zeman F, Heid IM, Baumert M. Nocturnal hypoxemic burden and micro- and macrovascular disease in patients with type 2 diabetes. Cardiovasc Diabetol. 2024;23:195.

    CAS 
    PubMed 
    PubMed Central 

    Google Scholar 

  • Leong WB, Nolen M, Thomas GN, Adab P, Banerjee D, Taheri S. The impact of hypoxemia on nephropathy in extremely obese patients with type 2 diabetes mellitus. J Clin Sleep Med. 2014;10:773–8.

    PubMed 
    PubMed Central 

    Google Scholar 

  • Leong WB, Jadhakhan F, Taheri S, Thomas GN, Adab P. The association between obstructive sleep apnea on diabetic kidney disease: a systematic review and meta-analysis. Sleep. 2016;39:301–8.

    PubMed 
    PubMed Central 

    Google Scholar 

  • Hansrivijit P, Puthenpura MM, Ghahramani N, Thongprayoon C, Cheungpasitporn W. Bidirectional association between chronic kidney disease and sleep apnea: a systematic review and meta-analysis. Int Urol Nephrol. 2021;53:1209–22.

    PubMed 

    Google Scholar 

  • Hwu D-W, Lin K-D, Lin K-C, Lee Y-J, Chang Y-H. The association of obstructive sleep apnea and renal outcomes-a systematic review and meta-analysis. BMC Nephrol. 2017;18:313.

    PubMed 
    PubMed Central 

    Google Scholar 

  • Wang B, Li Z-L, Zhang Y-L, Wen Y, Gao Y-M, Liu B-C. Hypoxia and chronic kidney disease. EBioMedicine. 2022;77: 103942.

    CAS 
    PubMed 
    PubMed Central 

    Google Scholar 

  • Friederich-Persson M, Thörn E, Hansell P, Nangaku M, Levin M, Palm F. Kidney hypoxia, attributable to increased oxygen consumption, induces nephropathy independently of hyperglycemia and oxidative stress. Hypertension. 2013;62:914–9.

    CAS 
    PubMed 

    Google Scholar 

  • Zalucky AA, Nicholl DDM, Hanly PJ, Poulin MJ, Turin TC, Walji S, et al. Nocturnal hypoxemia severity and renin-angiotensin system activity in obstructive sleep apnea. Am J Respir Crit Care Med. 2015;192:873–80.

    CAS 
    PubMed 

    Google Scholar 

  • Piani F, Melena I, Tommerdahl KL, Nokoff N, Nelson RG, Pavkov ME, et al. Sex-related differences in diabetic kidney disease: a review on the mechanisms and potential therapeutic implications. J Diabetes Complic. 2021;35: 107841.

    CAS 

    Google Scholar 

  • Steiger S, Li L, Bruchfeld A, Stevens KI, Moran SM, Floege J, et al. Sex dimorphism in kidney health and disease: mechanistic insights and clinical implication. Kidney Int. 2025;107:51–67.

    CAS 
    PubMed 

    Google Scholar 

  • Shepard BD. Sex differences in diabetes and kidney disease: mechanisms and consequences. Am J Physiol Renal Physiol. 2019;317:F456–62.

    CAS 
    PubMed 
    PubMed Central 

    Google Scholar 

  • Shen Y, Cai R, Sun J, Dong X, Huang R, Tian S, Wang S. Diabetes mellitus as a risk factor for incident chronic kidney disease and end-stage renal disease in women compared with men: a systematic review and meta-analysis. Endocrine. 2017;55:66–76.

    CAS 
    PubMed 

    Google Scholar 

  • Herrington WG, Staplin N, Wanner C, Green JB, Hauske SJ, Emberson JR, et al. Empagliflozin in patients with chronic kidney disease. N Engl J Med. 2023;388:117–27.

    CAS 
    PubMed 

    Google Scholar 

  • Bakris GL, Agarwal R, Anker SD, Pitt B, Ruilope LM, Rossing P, et al. Effect of finerenone on chronic kidney disease outcomes in type 2 diabetes. N Engl J Med. 2020;383:2219–29.

    CAS 
    PubMed 

    Google Scholar 

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