Risk factors associated with poor sleep quality in maintenance hemodialysis patients: A single-center cross-sectional...

Poor sleep quality is common in patients receiving maintenance hemodialysis (MHD) and may worsen symptom burden and outcomes. This study evaluated Pittsburgh sleep quality index (PSQI)-defined poor sleep quality and its associated factors in a single-center MHD cohort. This single-center cross-sectional study included 143 patients receiving MHD at the Fifth People's Hospital of Jinan from June to December 2024. Sleep quality was assessed using the PSQI. Patients were categorized as having good sleep quality (PSQI < 5) or poor sleep quality (PSQI ≥ 5). Demographic, clinical, dialysis-related, and laboratory variables were collected, including dialysis vintage, residual urine volume, weekly dialysis frequency, and dialysis adequacy assessed by standard weekly Kt/V (stdKt/V). An exploratory subgroup analysis was also performed in patients with diabetes mellitus. Of the 143 patients, 76 (53.1%) had poor sleep quality. Significant between-group differences were observed for age, diabetes mellitus, restless legs syndrome (RLS), and dialysis adequacy (all P < .05). In univariable logistic regression, older age (odds ratio [OR] 1.044, 95% CI: 1.013-1.076, P = .005), diabetes mellitus (OR 3.041, 95% CI: 1.518-6.096, P = .002), RLS (OR 3.717, 95% CI: 1.647-8.392, P = .002), and stdKt/V < 2.1 (OR 2.562, 95% CI: 1.218-5.389, P = .013) were associated with poor sleep quality. In multivariable model 1, older age (per 1-year increase; OR 1.041, 95% CI: 1.005-1.079, P = .027), diabetes mellitus (OR 2.625, 95% CI: 1.194-5.772, P = .016), and stdKt/V < 2.1 (OR 2.875, 95% CI: 1.264-6.542, P = .012) remained independently associated with poor sleep quality, whereas female sex was not significant (OR 1.801, 95% CI: 0.775-4.185, P = .171). In model 2, diabetes mellitus (OR 2.609, 95% CI: 1.184-5.749, P = .017), stdKt/V < 2.1 (OR 2.346, 95% CI: 1.039-5.296, P = .040), and RLS (OR 3.002, 95% CI: 1.175-7.668, P = .022) remained significant. In an exploratory subgroup analysis of patients with diabetes mellitus, calcium-phosphorus product > 55 mg2/dL2 was associated with poor sleep quality. Poor sleep quality was common in this MHD cohort and was associated with older age, diabetes mellitus, RLS, and lower dialysis adequacy. In patients with diabetes mellitus, the calcium-phosphorus product finding should be interpreted as exploratory.