Avaliação do cronotipo em pacientes com doença renal crônica em hemodiálise

Abstract

Chronic kidney disease (CKD) is associated with significant morbidity and mortality and can negatively affect many aspects of health and well-being. In this group of patients, especially in the advanced stage of the disease, in need of dialysis or kidney transplantation, there is a higher prevalence of sleep disorders, such as those related to circadian rhythm alterations, and Restless Legs Syndrome/Willis-Ekbom disease (SPI/WED). The objectives of the present study were to evaluate the chronotype of CKD patients undergoing hemodialysis, investigate the prevalence of RLS/WED, the existence of social jetlag related to hemodialysis, the discordance between dialysis shift and chronotypes, and the association of these conditions with sleep quality, excessive daytime sleepiness (EDS) and quality of life (QoL), using a specific measure for this population. This is a cross-sectional study that included, from February to June 2022, 165 patients on hemodialysis 3 times a week in three local units. The following instruments were used: Morning-Evening Questionnaire (MEQ); a modified version of the Munich Chronotype Questionnaire (MCQT) to estimate hemodialysis-related jetlag (HJL); Kidney Disease and Quality-of-Life Short-Form (KDQOL-SF); Epworth Sleepiness Scale (ESS); Pittsburgh Sleep Quality Index (PSQI), 10–Cognitive Screener (10-CS), STOP-Bang for sleep apnea screening, and the single question for RLS/WED screening. The mean age of patients was 51.12 years (± 12.5 years), 60.6% were male, and 34 patients (20.6%) were undergoing treatment in the morning shift, 88 (50.3% ) in the afternoon shift and 43 (26.1%) in the night shift. The morning chronotype was the most prevalent (69%) compared to the afternoon type (17.1%) and is significantly different from a matched sample of the general population (p<0.001). The prevalence of RLS/WED was 29.7%, being higher in patients on the morning shift (47.1% vs. 22.7% and 30.2%; p=0.031), as well as the persistent chronic form, with a prevalence of 18.8%, also higher in the morning shift (41.2% vs. 14.8% and 9.3%; p<0.001). EDS was observed in 32.1%. HJL was present in 40.6% of patients with CKD, with a mean of 54.5 ± 64.6min (0- 297.6min). HJL and chronotype were associated with different domains of quality of life, but not with sleep quality. Disagreement between shift treatment and chronotype was detected in 11.5% and was related to higher MEQ scores (p<0.001), but was not associated with quality of life, QoL or HJL. Patients with RLS/WED had significantly worse KDQOL-SF scores in several domains such as: functional capacity (p=0.027), physical limitation (p=0.004), social interaction (p=0.04), symptoms (p=0.002) , kidney disease burden (p=0.007), cognitive function (p=0.002) and sleep (p<0.001). The persistent form of RLS/WED and poor sleep quality were also associated with lower scores in multiple quality of life domains. Multivariate analysis showed that RLS/WED was associated with worse quality of life in several domains of the KDQOL-SF, in particular physical limitation. In summary, this study suggests that JHL exists and that the morning chronotype is associated with patients with CKD on hemodialysis with implications for QoL, and also that RLS/WED is common in patients on hemodialysis, being associated with a worse perception of quality of life in multiple domains.