Impact of obstructive sleep apnea on early renal injury biomarkers: A systematic review and meta-analysis
Abstract
Introduction: Obstructive sleep apnea (OSA) is increasingly recognized as a potential contributor to early renal injury. However, whether OSA independently affects kidney function in individuals without known kidney disease remains uncertain. Early identification of subclinical renal damage is crucial for timely intervention.
Methods: A systematic search was conducted across PubMed, Embase, MEDLINE, Web of Science, Scopus, and Cochrane Library databases from inception to July 7, 2025. Eligible studies included adults without diagnosed chronic kidney disease and reported at least one renal biomarker. Pooled standardized mean differences (SMDs) and 95 % confidence intervals (CIs) were calculated, and correlation coefficients were converted to Fisher z-scores for pooling.
Results: Twenty-six studies with 4302 participants were included. Compared to non-OSA controls, OSA patients exhibited significantly higher levels of urinary microalbumin (UmAlb) (SMD = 0.79), cystatin C (CysC) (SMD = 0.47), urine albumin-to-creatinine ratio (uACR) (SMD = 0.49), neutrophil gelatinase-associated lipocalin (NGAL) (SMD = 0.34), and interleukin-18 (IL-18) (SMD = 2.27) (all P 2-MG and L-FABP were only described qualitatively due to insufficient data for pooling. Subgroup analyses showed stronger biomarker elevations in severe OSA and hypertensive individuals. Apnea-hypopnea index (AHI) and hypoxia indices correlated positively with biomarker levels.
Conclusions: OSA was associated with multiple…
How strong is the evidence?
Evidence Hub reads this as a meta-analysis, done in people. Its evidence level is 1 of 5 (Highest · pooled evidence). Pooled evidence from several studies sits at the top of the evidence pyramid. Reported size: 4,302 participants or records.
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