OSA Increases CKD Risk in Recovered Acute Cardiogenic Pulmonary Edema

Obstructive sleep apnea (OSA) increases the risk for chronic kidney disease (CKD) in patients who have recovered from an episode of acute cardiogenic pulmonary edema (ACPE), according to research presented at the World Sleep Meeting 2019, held September 20 to 25, in Vancouver, Canada.

Consecutive patients with clinically confirmed ACPE were recruited from the emergency department at the University of São Paolo Heart Institute in Brazil (n=55). The mean age of the cohort was 67±11 years and mean body mass index was 27.1 kg/m² (range, 24.6-31.2 kg/m²). Patients were treated with standard therapy and their ACPE was stabilized approximately 30 days following treatment.

Patients underwent sleep monitoring to identify OSA, which was defined by an apnea-hypopnea-index (AHI) of ≥15 events/h. The Chronic Kidney Disease: Epidemiology Consortium (CKD-EPI) equations were used to estimate patients’ glomerular filtration rate (eGFR). CKD incidence was calculated for each patient using an eGFR of <60mL/min/1.73m² after 1 year of follow-up.

In the cohort of patients recovered from ACPE, the frequency rate of OSA was 63.6%. The calculated eGFR trended toward a greater reduction in patients with OSA vs patients without OSA at 1-year follow-up (-5.4 ±15.9 mL/min/1.73m² vs -2.03±21.3 mL/min/1.73m², respectively; P =.053). Patients with OSA had a greater increase in the incidence of CKD from baseline to 1 year (82.9%-91.4% vs 62.2%-65%, respectively; P =.05).

Study limitations included the small number of patients, as well as the recruitment of patients from a single center.

The study researchers suggested that their finding “may partially explain the poor prognosis of patients with OSA who recovered from a previous ACPE.”

Reference

Furlan SF, de Macedo TA, Giovanini G, et al. The impact of obstructive sleep apnea on chronic kidney disease incidence after acute cardiogenic pulmonary edema: a sub-analysis of OSA-Care Study. Presented at: World Sleep Meeting 2019; September 20-25, 2019; Vancouver, Canada. Abstract 253.