Using Continuous Positive Airway Pressure to Reduce the Incidence of Acute Kidney Injury in Hospitalized Patients With Chronic Kidney Disease

Study Overview
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Brief Summary
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Obstructive sleep apnea (OSA) is a common and undertreated condition in patients with chronic kidney disease (CKD). Both physiologic and empiric data suggest that renal hypoxia due to OSA is associated with worsening kidney function. Hospitalized patients are often exposed to multiple nephrotoxins such as antibiotics, contrast agents, and diuretics, which place them at risk for acute worsening of kidney function. This study aims to determine whether immediate diagnosis and treatment of OSA in CKD patients will decrease the incidence of acute kidney injury during hospitalization. The investigators will evaluate the extent to which this effect can be attributed to a decrease in nocturnal hypoxia and improved blood pressure control. Secondary endpoints include hospital length of stay, and a composite outcome comprised of hemodialysis initiation, major cardiovascular events, and mortality.

Official Title
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Using CPAP to Prevent Acute Kidney Injury in Hospitalized Patients With Chronic Kidney Disease

Conditions
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Chronic Kidney Disease, Obstructive Sleep Apnea

Intervention / Treatment
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* Device: CPAP/autopap


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: CKD defined by National Kidney Foundation Staging system: eGFR < 60 Overnight sleep study consistent with OSA Exclusion Criteria: Currently treated with positive airway pressure for sleep-disordered breathing Hemodynamically unstable, defined as SBP < 90, or use of vasopressors Intubated or mechanically ventilated Respiratory insufficiency, defined as P/F ratio < 250, or requiring mechanical ventilation End stage renal disease on renal replacement therapy Contraindication to CPAP, including active emesis, recent intracranial surgery, altered level of consciousness

Ages Eligible for Study
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Minimum Age: 19 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Prevention
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| No Intervention: Control<br> | |
| Experimental: Intervention<br>CPAP/autopap | Device: CPAP/autopap<br> <br> |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Incidence of acute kidney injury | incidence of acute kidney injury during hospitalization (defined as an increase in creatinine by 0.5 mg/dl or more) | participants will be followed for the duration of hospital stay, an expected average of 5 days | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Nocturnal hypoxia | Nocturnal hypoxia, defined as oxygen saturation < 88% | participants will be followed for the duration of hospital stay, an expected average of 5 days | 
| Blood pressure control | Blood pressure control, defined as incidence of SBP > 160 | participants will be followed for the duration of hospital stay, an expected average of 5 days | 
| Hospital length of stay | Hospital length of stay | participants will be followed for the duration of hospital stay, an expected average of 5 days | 
| composite outcome | Composite outcome of a) Incidence of major cardiovascular event (acute coronary syndrome, major arrhythmia, or exacerbation of CHF), b) Initiation of hemodialysis c)In-hospital mortality | participants will be followed for the duration of hospital stay, an expected average of 5 days | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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chronic kidney disease, acute kidney injury, obstructive sleep apnea