Association of sleep disorders, chronic pain, and fatigue with survival in patients with chronic kidney disease: a meta-analysis of clinical trials

Objective: Sleep disorders, chronic pain, and fatigue have been long-standing torments in most patients with chronic kidney disease (CKD). In this review, we attempted to explore whether these nontraditional cardiovascular risk factors are associated with increased mortality in patients with CKD.

Method: Electronic searches were performed in MEDLINE (PubMed, 1966-2018), EMBASE (1974-2018), ClinicalTrials.gov, and the Cochrane Central Register of Controlled Trials databases. All prospective or retrospective studies were considered eligible if they were cohort or observational studies and the final outcome was all-cause death or mortality.

Results: We ultimately included 18 studies (12 studies on sleep disorders, three studies on chronic pain, and three studies on fatigue) in our review. Pooled analysis of all studies indicated that patients with sleep disorders, chronic pain, and fatigue had increased risks of all-cause mortality (risk ratio [RR] = 1.47, 95% confidence interval [CI] = 1.30-1.66, p < 0.0001; RR = 1.29, 95% CI = 1.27-1.31, p < 0.0001; RR = 1.45, 95% CI = 1.23-1.70, p < 0.0001, respectively). Pooled results from four studies indicated that dialysis patients with sleep-disordered breathing had increased cardiovascular disease outcomes (RR = 2.45, 95% CI = 1.74-3.44, p < 0.0001).

Conclusion: Sleep disorders, chronic pain, and fatigue are remarkably associated with increased all-cause mortality in patients with CKD. Large clinical randomized controlled trials are required to further confirm the results of our meta-analysis.