Association Between Stressful Life Events and Chronic Kidney Disease: A Cross-Sectional Study from the Nationally Representative CHARLS

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While the association between stressful life events (SLEs) and cardiovascular/metabolic diseases has been extensively studied, their impact on chronic kidney disease (CKD) remains unclear.To explore the association between SLEs exposure and CKD prevalence among Chinese middle-aged and elderly adults, and evaluate sleep's mediating effect.Data were from CHARLS.SLEs were assessed using 6 items, and CKD was defined by self-reported physician diagnosis or estimated glomerular filtration rate.Subgroup and interaction analyses assessed variations across populations.Bootstrap mediation analysis examined sleep's role in SLEs-CKD association.Multivariate logistic regression models examined correlation between SLEs (categorized as 0, 1, and >1 event) and CKD.Multiple sensitivity analyses, including multiple imputation, exclusion of health-related stress indicators, and modification of outcome definitions, verified robustness of the correlation.SLEs count was positively associated with CKD prevalence risk: 26% higher for 1 SLE (OR=1.26,95%CI:1.03-1.55,P=0.026) and 72% higher for multiple SLEs (OR=1.72,95%CI:1.41-2.11,P<0.001).Subgroup analyses revealed that this association was consistent across age, sex, hypertension, and diabetes subgroups (no interaction, P-interaction>0.05).Mediation analysis revealed that sleep partially mediated the SLEs-CKD association (mediation proportion:7.69%).Sensitivity tests validated the stability of this correlation after addressing missing data (N = 8,756), eliminating reverse causality bias, and adopting alternative eGFR cutoff values.SLEs are independently positively associated with CKD, with risk increasing with SLEs count; sleep plays a partial mediating role.These findings provide new epidemiological evidence for stress management in CKD prevention and control.