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Insomnia in patients on incident maintenance dialysis and the risk of major acute cardio-cerebrovascular events and all-cause mortality

Authors
 Hyung Woo Kim  ;  Ga Young Heo  ;  Hyo Jeong Kim  ;  Shin-Wook Kang  ;  Jung Tak Park  ;  Eun Lee 
Citation
 NEPHROLOGY DIALYSIS TRANSPLANTATION, Vol.39(5) : 830-837, 2024-04 
Journal Title
NEPHROLOGY DIALYSIS TRANSPLANTATION
ISSN
 0931-0509 
Issue Date
2024-04
MeSH
Aged ; Cardiovascular Diseases* / etiology ; Cardiovascular Diseases* / mortality ; Cause of Death ; Cerebrovascular Disorders* / epidemiology ; Cerebrovascular Disorders* / etiology ; Cerebrovascular Disorders* / mortality ; Female ; Humans ; Incidence ; Kidney Failure, Chronic* / complications ; Kidney Failure, Chronic* / mortality ; Kidney Failure, Chronic* / therapy ; Male ; Middle Aged ; Renal Dialysis* / adverse effects ; Republic of Korea / epidemiology ; Retrospective Studies ; Risk Factors ; Sleep Initiation and Maintenance Disorders* / complications
Keywords
ESKD ; cardio-cerebrovascular disease ; dialysis ; insomnia ; mortality
Abstract
Background. Insomnia is a known risk factor for cardio-cerebrovascular disease in the general population; however, its effect on cardio-cerebrovascular outcomes in end-stage kidney disease patients is unclear. Therefore, this study aimed to investigate the asso- ciation between cardio-cerebrovascular outcomes and insomnia in patients who initiated maintenance dialysis. Methods. This study used nationwide Korean health insurance claims data to analyze 79 420 patients who initiated maintenance dialysis from January 2009 to December 2017. Insomnia was defined using claim codes and sleep medication prescription data. Patients were categorized according to the presence of insomnia before and after dialysis initiation: (i) no insomnia, (ii) insomnia before dialysis only (improved insomnia), (iii) insomnia after dialysis only (developed insomnia) and (iv) insomnia in both periods (persistent insomnia). The primary and secondary outcomes were major adverse cardiac and cerebrovascular events (MACCE) and all-cause mortality, respectively. The outcome risks were estimated by Cox regression models with inverse probability of treatment weighting. Results. The mean age was 61.4 ±13.4 years, and 39.7% were women. During the transition period from pre-dialysis to maintenance dialysis, 13.2% experienced insomnia. The insomnia groups showed significantly higher risks for MACCE [weighted hazard ratios (95% confidence intervals): developed insomnia, 1.26 (1.25–1.28); improved insomnia, 1.31 (1.29–1.33); persistent insomnia, 1.39 (1.37–1.41)] and higher all-cause mortality risks than the no insomnia group. The insomnia-related cardio-cerebrovascular disease risk elevation was more prominent in younger and male patients. Conclusions. Insomnia may increase cardio-cerebrovascular disease and all-cause mortality risk among end-stage kidney disease patients who initiate maintenance dialysis.
Full Text
https://academic.oup.com/ndt/article/39/5/830/7342463
DOI
10.1093/ndt/gfad231
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Psychiatry (정신과학교실) > 1. Journal Papers
Yonsei Authors
Kang, Shin Wook(강신욱) ORCID logo https://orcid.org/0000-0002-5677-4756
Kim, Hyung Woo(김형우) ORCID logo https://orcid.org/0000-0002-6305-452X
Park, Jung Tak(박정탁) ORCID logo https://orcid.org/0000-0002-2325-8982
Lee, Eun(이은) ORCID logo https://orcid.org/0000-0002-7462-0144
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/199797
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