Effect of positive airway pressure on glomerular filtration rate in patients with sleep-disordered breathing: a meta-analysis.
OBJECTIVE
Sleep-disordered breathing (SDB) has been suggested to be associated with chronic kidney disease (CKD). Positive airway pressure (PAP) is an effective treatment for SDB, but the impact of PAP therapy on glomerular filtration rate (GFR) in patients with SDB remains unclear. The present meta-analysis was performed to determine whether PAP therapy could increase GFR.


METHODS
A systematic search of PubMed, Embase, Web of Science, and Cochrane library was performed for literature published up to January 2016. Standardized mean difference (SMD) was calculated to estimate the treatment effects of pre- and post-PAP therapy.


RESULTS
A total of eight studies with 240 patients were pooled into a meta-analysis. The meta-analysis showed that there was no change of GFR before and after PAP treatment in SDB patients (SMD = 0.010, 95 % confidence interval (CI) = -0.331 to 0.350, z = 0.06, p = 0.956), Subgroup analyses indicated that GFR was significantly increased after PAP treatment in elder patients (≥55 years) (SMD = -0.283, 95 % CI = -0.518 to -0.047, z = 2.35, p = 0.019) and patients with therapeutic duration ≥ 3 months (SMD = -0.276, 95 % CI = -0.522 to -0.031, z = 2.20, p = 0.027).


CONCLUSIONS
The present meta-analysis suggested that PAP treatment had no impact on GFR in SDB patients. However, longer PAP usage for SDB patients significantly improved GFR. In elder SDB subjects, PAP was also associated with a statistically significant increase in GFR.
Department of Respiratory Medicine, Zhangzhou Affiliated Hospital of Fujian Medical University, No 59, Shenglixi road, Xiangcheng district, Zhangzhou, Fujian province, 363000, People's Republic of China.
Li-Da
LD
Chen
Department of Respiratory Medicine, Zhangzhou Affiliated Hospital of Fujian Medical University, No 59, Shenglixi road, Xiangcheng district, Zhangzhou, Fujian province, 363000, People's Republic of China.
Li
L
Lin
Department of Respiratory Medicine, Zhangzhou Affiliated Hospital of Fujian Medical University, No 59, Shenglixi road, Xiangcheng district, Zhangzhou, Fujian province, 363000, People's Republic of China.
Yang-Wu
YW
Ou
Department of Respiratory Medicine, Zhangzhou Affiliated Hospital of Fujian Medical University, No 59, Shenglixi road, Xiangcheng district, Zhangzhou, Fujian province, 363000, People's Republic of China.
Zhi
Z
Wu
Department of Respiratory Medicine, Zhangzhou Affiliated Hospital of Fujian Medical University, No 59, Shenglixi road, Xiangcheng district, Zhangzhou, Fujian province, 363000, People's Republic of China.
Zhi-Ming
ZM
Cai
Department of Respiratory Medicine, Zhangzhou Affiliated Hospital of Fujian Medical University, No 59, Shenglixi road, Xiangcheng district, Zhangzhou, Fujian province, 363000, People's Republic of China.
Tie-Zhu
TZ
Wang
Department of Respiratory Medicine, Zhangzhou Affiliated Hospital of Fujian Medical University, No 59, Shenglixi road, Xiangcheng district, Zhangzhou, Fujian province, 363000, People's Republic of China. ljnzzsy123@163.com.
Jian-Nan
JN
Liu
D000328:Adult; D045422:Continuous Positive Airway Pressure / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate / Q000502:physiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D020181:Sleep Apnea, Obstructive / Q000503:physiopathology* / Q000628:therapy*; D013997:Time Factors
Chronic kidney disease; Glomerular filtration rate; Meta-analysis; Positive airway pressure; Sleep-disordered breathing