Effect of positive airway pressure on glomerular filtration rate in patients with sleep-disordered breathing: a meta-analysis

Abstract

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. 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. 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 (≥55years) (SMD=-0.283, 95% CI=-0.518 to -0.047, z=2.35, p=0.019) and patients with therapeutic duration≥3months (SMD=-0.276, 95% CI=-0.522 to -0.031, z=2.20, p=0.027). 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.