Associations of sleeping patterns and isotemporal substitution of other behavior with the prevalence of CKD in Chinese adults

Abstract

Studies have found a U-shaped relationship between sleep duration and chronic kidney disease (CKD) risk, but limited research evaluated the association of reallocating excessive sleep to other behavior with CKD. We included 104 538 participants from the nationwide cohort of the Risk Evaluation of Cancers in Chinese Diabetic Individuals: A Longitudinal Study, with self-reported time of daily-life behavior. Using isotemporal substitution models, we found that substituting 1 h of sleeping with sitting, walking, or moderate-to-vigorous physical activity was associated with a lower CKD prevalence. Leisure-time physical activity displacement was associated with a greater prevalence reduction than occupational physical activity in working population. In stratified analysis, a lower CKD prevalence related to substitution toward physical activity was found in long sleepers. More pronounced correlations were observed in long sleepers with diabetes than in those with prediabetes, and they benefited from other behavior substitutions toward a more active way. The U-shaped association between sleep duration and CKD prevalence implied the potential effects of insufficient and excessive sleep on the kidneys, in which the pernicious link with oversleep could be reversed by time reallocation to physical activity. The divergence in the predicted effect on CKD following time reallocation to behavior of different domains and intensities and in subpopulations with diverse metabolic statuses underlined the importance of optimizing sleeping patterns and adjusting integral behavioral composition.

Keywords

sleep / physical activity / chronic kidney disease / isotemporal substitution / behavioral pattern

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Acknowledgements

The authors thank all the staff and study participants for their important contributions. This work was supported by the grants from the National Natural Science Foundation of China (Nos. 82088102, 91857205, 82022011, 81970728, and 81930021), the Shanghai Rising-Star Program (No. 21QA1408100), Shanghai Outstanding Academic Leaders Plan (No. 20XD1422800), the National Top Young Scholar Program (Yu Xu), the Innovative Research Team of High-Level Local Universities in Shanghai, the Shanghai Clinical Research Center for Metabolic Diseases (No. 19MC1910100) and the Shanghai Shen Kang Hospital Development Center (Nos. SHDC2020CR1001A and SHDC2020CR3064B).

Electronic Supplementary Material

Supplementary material is available in the online version of this article at https://doi.org/10.1007/s11684-023-1019-5 and is accessible for authorized users.

Compliance with ethics guidelines

Conflicts of interest Yi Ding, Xiaoli Xu, Zhuojun Xin, Qiuyu Cao, Jiaojiao Huang, Xianglin Wu, Yanan Huo, Qin Wan, Yingfen Qin, Ruying Hu, Lixin Shi, Qing Su, Xuefeng Yu, Li Yan, Guijun Qin, Xulei Tang, Gang Chen, Min Xu, Tiange Wang, Zhiyun Zhao, Zhengnan Gao, Guixia Wang, Feixia Shen, Zuojie Luo, Li Chen, Qiang Li, Zhen Ye, Yinfei Zhang, Chao Liu, Youmin Wang, Tao Yang, Huacong Deng, Lulu Chen, Tianshu Zeng, Jiajun Zhao, Yiming Mu, Shengli Wu, Yuhong Chen, Jieli Lu, Weiqing Wang, Guang Ning, Yu Xu, Yufang Bi, and Mian Li declare that they have no conflict of interest.

The study was approved (or granted exemption) by the Medical Ethics Committee of Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine and the study was performed in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards. Informed consent was obtained from all patients for being included in the study.

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