Disrupted rest-activity circadian rhythms are associated with all-cause mortality in patients with chronic kidney diseases

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 (<i>n</i> = 1114; Mean [95% CI]: Age, 50 [58-61] y; 52% female) were compared with non-CKD individuals (<i>n</i> = 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<i>s</i> <i><</i> 0.001). Among CKD patients, a lower rhythmic amplitude (HR [95% CI]: 0.88 [0.82-0.96]; <i>p</i> < 0.001), a lower rhythm adjusted mean (0.87 [0.81-0.95]; <i>p</i> = 0.002), and a higher daily activity fragmentation (1.87 [1.10-3.18]; <i>p</i> = 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.