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Abstract
Obstructive sleep apnea (OSA) is a recognized risk factor for the development of diabetic kidney disease (DKD). Our objectives were to compare the urinary albumin–creatinine ratio (UACR) and estimated glomerular filtration rate (eGFR) of patients with DKD according to OSA severity, and to evaluate the contribution of sleep parameters to their renal function. In a multicenter, observational, cross-sectional study, 214 patients with DKD were recruited. After a sleep study, UACR and eGFR were measured, as well as serum creatinine, fasting glucose, glycated hemoglobin, insulin resistance, lipid profile and C-reactive protein. UACR was higher in severe OSA patients (920 ± 1053 mg/g) than in moderate (195 ± 232 mg/g, p < 0.001) or mild OSA/non-OSA subjects (119 ± 186 mg/g, p < 0.001). At the same time, eGFR showed an OSA severity-dependent reduction (48 ± 23 vs. 59 ± 21 vs. 73 ± 19 ml/min per 1.73 m2, respectively; p < 0.001). Apnea–hypopnea index (AHI and desaturation index (ODI) were identified as independent predictors for UACR and eGFR, respectively. Therefore, in patients with DKD under optimized treatment, severe OSA is associated with a higher UACR and a lower eGFR, reflecting an additional contribution to the impairment of their renal function, although no causality can be inferred.
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1 Hospital Universitario La Paz-IdiPAZ, Servicio de Neumología, Madrid, Spain (GRID:grid.81821.32) (ISNI:0000 0000 8970 9163)
2 Hospital Universitario Ramón y Cajal, Servicio de Neumología, Madrid, Spain (GRID:grid.411347.4) (ISNI:0000 0000 9248 5770)
3 Hospital Universitario, Servicio de Neumología, Madrid, Spain (GRID:grid.411171.3) (ISNI:0000 0004 0425 3881); Centro de Investigación Biomédica en Red en Enfermedades Respiratorias (CIBERES), Madrid, Spain (GRID:grid.413448.e) (ISNI:0000 0000 9314 1427)
4 Centro de Investigación Biomédica en Red en Enfermedades Respiratorias (CIBERES), Madrid, Spain (GRID:grid.413448.e) (ISNI:0000 0000 9314 1427); Hospital Universitario Son Espases, Servicio de Neumología, Palma de Mallorca, Spain (GRID:grid.411164.7) (ISNI:0000 0004 1796 5984); Institut d’Investigació Sanitària Illes Balears (IdISBa), Palma de Mallorca, Spain (GRID:grid.507085.f)
5 Hospital Universitario Infanta Sofía, Servicio de Neumología, Madrid, Spain (GRID:grid.414758.b) (ISNI:0000 0004 1759 6533)
6 Centro de Investigación Biomédica en Red en Enfermedades Respiratorias (CIBERES), Madrid, Spain (GRID:grid.413448.e) (ISNI:0000 0000 9314 1427); Hospital Universitario de Guadalajara, Servicio de Neumología, Guadalajara, Spain (GRID:grid.411098.5); Universidad de Alcalá, Madrid, Spain (GRID:grid.7159.a) (ISNI:0000 0004 1937 0239)
7 Centro de Investigación Biomédica en Red en Enfermedades Respiratorias (CIBERES), Madrid, Spain (GRID:grid.413448.e) (ISNI:0000 0000 9314 1427); Fundación Jiménez Díaz, Servicio de Neumología, Madrid, Spain (GRID:grid.419651.e)
8 Institut d’Investigació Sanitària Illes Balears (IdISBa), Palma de Mallorca, Spain (GRID:grid.507085.f); Hospital Universitario Son Espases, Servicio de Nefrología, Palma de Mallorca, Spain (GRID:grid.411164.7) (ISNI:0000 0004 1796 5984)
9 Hospital Universitario, Servicio de Nefrología, Madrid, Spain (GRID:grid.411171.3) (ISNI:0000 0004 0425 3881)
10 Hospital Universitario de Guadalajara, Servicio de Neumología, Guadalajara, Spain (GRID:grid.411098.5)
11 Hospital Universitario La Paz-IdiPAZ, Servicio de Neumología, Madrid, Spain (GRID:grid.81821.32) (ISNI:0000 0000 8970 9163); Centro de Investigación Biomédica en Red en Enfermedades Respiratorias (CIBERES), Madrid, Spain (GRID:grid.413448.e) (ISNI:0000 0000 9314 1427); Universidad Autónoma de Madrid, Departamento de Medicina, Facultad de Medicina, Madrid, Spain (GRID:grid.5515.4) (ISNI:0000000119578126)
12 Hospital Universitario, Servicio de Neumología, Madrid, Spain (GRID:grid.411171.3) (ISNI:0000 0004 0425 3881)
13 Institut d’Investigació Sanitària Illes Balears (IdISBa), Palma de Mallorca, Spain (GRID:grid.507085.f)
14 Hospital Universitario La Paz, Servicio de Endocrinología, Madrid, Spain (GRID:grid.81821.32) (ISNI:0000 0000 8970 9163)
15 Hospital Universitario La Paz-IdiPAZ, Servicio de Neumología, Madrid, Spain (GRID:grid.81821.32) (ISNI:0000 0000 8970 9163); Centro de Investigación Biomédica en Red en Enfermedades Respiratorias (CIBERES), Madrid, Spain (GRID:grid.413448.e) (ISNI:0000 0000 9314 1427)
16 Hospital Universitario La Paz, Servicio de Nefrología, Madrid, Spain (GRID:grid.81821.32) (ISNI:0000 0000 8970 9163)
17 Hospital Universitario Son Espases, Servicio de Neumología, Palma de Mallorca, Spain (GRID:grid.411164.7) (ISNI:0000 0004 1796 5984)
18 Fundación Jiménez Díaz, Servicio de Neumología, Madrid, Spain (GRID:grid.419651.e)