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Background Chronic insomnia is highly prevalent in the world. Its effects on the sympatho-adrenal system could potentially worsen hypertension and cause metabolic abnormalities. However, there is lack of evidence of the association between insomnia and adverse renal outcomes.

Methods We examined associations of chronic insomnia (defined as the presence of ICD9 codes 307.42, 307.49 and 780.52 and long-term use of insomnia medications) with all-cause mortality and renal outcomes, (ESRD, incidence of eGFR 60 ml/min/1.73m 2. Associations were examined in Cox proportional hazards models and logistic regressions. Besides crude models (model 1), adjustments were made for demographics and baseline estimated GFR (model 2), BMI and blood pressure (Model 3), comorbidities, antihypertensive drugs, and social-economic status (Model 4). Results 41,928 patients (4.4%) had chronic insomnia. Over a 6.1-year median follow-up period, 23.1% of patients died [mortality rate: 39.4/1000 patient-years (PY)], 0.2% reached ESRD (event rate: 0.2/1000PY), 6.6% of them progressed to eGFR.