**5. ASB in renal transplant recipients**

It has been found that up to 50% of renal transplant recipients have ASB and UTIs. Many risk factors contribute to the high incidence of UTIs and ASB, which can undermine graft function and survival. In a retrospective study the impact of ASB on renal transplant outcome was analysed in 189 renal transplant recipients. Screening resulted into 298 episodes of ASB in 96 recipients (follow-up 36 months). Significant risk factors included female gender, glomerulonephritis as the disease that led to transplantation, and double renal transplant. There were no differences in serum creatinine, creatinine clearance, or proteinuria between patients with and without bacteriuria. The incidence of pyelonephritis in these patients was 7.6 episodes per 100 patient-years compared with 1.1 in those without ASB. A total of 2-5 ASB episodes were independent factors associated with pyelonephritis whereas more than 5 episodes was a factor associated with rejection. Studies show contradictory results whether antibiotic treatment results into a lower prevalence of ASB in these patients.

**23**

*USA* 

**Sleep Disorders Associated** 

*1Department of Nephrology 2Department of Sleep Medicine* 

**with Chronic Kidney Disease** 

Robert L. Benz1, Mark R. Pressman2 and Iqbal Masood1

*Lankenau Medical Center and Lankenau Institute for Medical Research, Wynnewood,* 

Twenty-six million American adults have Chronic Kidney Disease (CKD). Chronic Kidney Disease is defined as kidney damage for 3 or more months with or without decreased GFR. Chronic Kidney Disease is divided into five stages, from Stage 1 to Stage 5. End-Stage renal disease is the 5th stage of CKD when dialysis is needed to sustain life. Sleep disorders are common and under recognized in advanced stages of Chronic Kidney Disease. Sleep disorders

Subjective sleep complaints are reported by more than 50% of patients on Hemodialysis (HD) (1). Common organic sleep disorders in patients with CKD include Sleep Apnea Syndrome (SAS), Periodic Limb Movement Disorder (PLMD) and Restless Leg Syndrome (RLS). These disorders are more common in the dialysis population than in the general population. When dialysis patients with a sleep disorders were studied objectively in sleep laboratory, 53% to 75% were found to have sleep apnea, which is higher than general population (2-4%) (2). Sleep disorders in CKD patients have been linked to increased incidences of cardiovascular disease including coronary artery disease, left ventricular hypertrophy and hypertension. (3, 4, 5, 6). Heart disease is the major cause of death in patients with CKD (www.kidney.org). In fact most patients who have advanced CKD and

affect the quality of life and may also increase cardiovascular morbidity and mortality.

are not on dialysis are more likely to die from heart disease before they start dialysis.

(49). Early diagnosis and treatment may improve quality of life.

**2. Subjective complaints in dialysis patients** 

Daytime somnolence resulting from sleep disorders may lead to diminished quality of life and cognition (7, 8).PLMD is associated with increased mortality in patients with ESRD.

Subjective sleep complaints are common in dialysis patients and include difficulty initiating and maintaining sleep, problems with restless, jerking legs, and/or day time sleepiness. Sleep disorders are very inconvenient for the patients and affect their activities of daily living. Most patients believe that relief of these symptoms would improve subjective quality of life. A large number of dialysis patients take sleep-inducing medications. Sleep complaints are more common in elderly patients on dialysis than in younger patients and

**1. Introduction** 
