Editors' ChoiceKidney Disease

Good sleep for healthy kidneys

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Science Translational Medicine  14 Oct 2020:
Vol. 12, Issue 565, eabe8124
DOI: 10.1126/scitranslmed.abe8124

Abstract

Poor sleep shows potential causal relationship with risk of developing chronic kidney disease.

Chronic kidney disease (CKD) is a major health problem worldwide. Observational studies have linked lower sleep duration and poor sleep quality to increased CKD incidence. However, the exact nature of the relationship between sleep and CKD has been difficult to elucidate due to multiple possible confounding factors.

Mendelian randomization (MR) takes advantage of the recent advent of large-scale genome wide association studies (GWAS) data to illuminate causal relationships. Briefly, MR can demonstrate the causal relationships between lifestyle factors on complex disease by considering the shared genetic risk between them, often in the form of genetic risk score. As genetics are fixed from birth and remain relatively stable throughout an individual’s lifetime, MR is minimally affected by reverse causation or confounding effects and thus can elucidate causal relationships.

Park et al. used MR to demonstrate the causal relationships between sleep duration and CKD. They utilized the UK Biobank, an unparalleled resource of 500,000 individuals with detailed lifestyle, medical, and genetic data. First, they conducted association analyses with self-reported short, intermediate, or long sleep duration with higher stages of CKD and found that both short and long sleep duration was associated with higher odds of CKD. In MR, genetic risk score for short but not long sleep duration was significantly related to a greater risk of CKD stages, suggesting causal relationship between short but not long sleep duration and CKD.

In addition to the obvious implications on clinical practice, in the form of clinicians advising patients, especially those at high risk of CKD, to practice good sleep hygiene, there might be broader implications on understanding the epidemiology and risk factors for CKD. With the aid of MR studies, causality can be elucidated, confounding disentangled from causation and progress made toward targeting casual relationships and biomarkers.

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