Department of Kinesiology and Health Sciences, Virginia Commonwealth University, Richmond, USA.
Department of Physics, Virginia Commonwealth University, Richmond, USA.
Chronobiol Int. 2024 Nov;41(11):1399-1410. doi: 10.1080/07420528.2024.2414045. Epub 2024 Oct 24.
Circadian rhythms are important biological contributors to health. Rest activity rhythms (RAR) are emerging as biomarkers of circadian behavior that are associated with chronic disease when abnormal. RAR have not yet been characterized in chronic kidney diseases (CKD). Leveraging the National Health and Nutrition Examination Survey (2011-2014), patients with CKD ( = 1114; Mean [95% CI]: Age, 50 [58-61] y; 52% female) were compared with non-CKD individuals ( = 5885; Age, 47 [46-48] y; 52% female). Actigraphy data were processed for RAR parameters including rhythmic strength (amplitude), the rhythm adjusted mean (mesor), the timing of peak activity (acrophase), activity regularity (inter-daily stability), and activity fragmentation (intra-daily variability). Cox regression was performed to assess RAR parameters for the prediction of all-cause mortality. Compared to non-CKD adults, patients with CKD had a lower rhythmic amplitude and mesor, and exhibited greater fragmentation and less day-to-day stability in RAR (p 0.001). Among CKD patients, a lower rhythmic amplitude (HR [95% CI]: 0.88 [0.82-0.96]; < 0.001), a lower rhythm adjusted mean (0.87 [0.81-0.95]; = 0.002), and a higher daily activity fragmentation (1.87 [1.10-3.18]; = 0.023) were associated with an increased risk of all-cause mortality. Patients with CKD showed dampened rhythmic amplitudes and greater fragmentation of activity that were associated with a higher risk of all-cause mortality. These findings demonstrate a relationship between circadian disruption and prognosis in patients with CKD.
昼夜节律是健康的重要生物学贡献者。休息活动节律（RAR）作为昼夜行为的生物标志物正在出现，当异常时与慢性疾病相关。在慢性肾脏病（CKD）中尚未描述 RAR。利用国家健康和营养检查调查（2011-2014 年），将 CKD 患者（ = 1114；平均[95%CI]：年龄，50 [58-61] y；52%女性）与非 CKD 个体（ = 5885；年龄，47 [46-48] y；52%女性）进行比较。为了评估 RAR 参数，对活动记录仪数据进行了处理，这些参数包括节律强度（幅度）、节律调整均值（中值）、峰值活动的时间（高峰时间）、活动规律性（日间稳定性）和活动碎片化（日内变异性）。进行 Cox 回归分析以评估 RAR 参数对全因死亡率的预测。与非 CKD 成年人相比，CKD 患者的节律幅度和中值较低，RAR 的碎片化程度更高，日间稳定性更差（p 0.001）。在 CKD 患者中，较低的节律幅度（HR [95%CI]：0.88 [0.82-0.96]； < 0.001）、较低的节律调整均值（0.87 [0.81-0.95]； = 0.002）和更高的日常活动碎片化（1.87 [1.10-3.18]； = 0.023）与全因死亡率增加相关。CKD 患者的节律幅度减弱和活动碎片化增加与全因死亡率增加相关。这些发现表明，昼夜节律紊乱与 CKD 患者的预后之间存在关系。
