Elevated Circulating NLRP3 Inflammasome Associated with Prevalent and Incident Chronic Kidney Disease in OSA Patients

Obstructive sleep apnea (OSA) is increasingly recognized for its association with chronic kidney disease (CKD). The NLRP3 inflammasome, a key component of the innate immune system, plays a crucial role in pathways involving hypoxia and inflammation, both of which are hallmarks of OSA pathophysiology. Understanding the specific mechanisms linking OSA to CKD progression is vital for early risk stratification and potential therapeutic interventions, as current standard-of-care often addresses symptoms without targeting underlying inflammatory drivers.

This single-center observational study enrolled 648 OSA patients to investigate the association between circulating NLRP3 levels and renal function. Researchers utilized multivariable linear and logistic regression models to assess associations with renal function indices and prevalent CKD. For incident CKD risk, Cox proportional hazards models and Kaplan-Meier analysis were employed. The study compared baseline characteristics, including nocturnal hypoxic burden, between CKD and non-CKD groups.

Patients with CKD exhibited a greater nocturnal hypoxic burden, including a higher apnea-hypopnea index (37.53 ± 18.80 vs. 29.74 ± 17.95 events/h) and higher T90 (18.37% vs. 10.84%) compared to the non-CKD group (all P < 0.01). Circulating NLRP3 was independently associated with a lower estimated glomerular filtration rate (eGFR) (β = -4.18, 95% CI -5.69 to -2.67; P < 0.001) and higher logarithmically transformed urinary albumin-to-creatinine ratio [ln(UACR)] (β = 0.14, 95% CI 0.08 to 0.21; P < 0.001).