Poor sleep quality was common in maintenance hemodialysis patients (53.1%) and was independently associated with older age, diabetes mellitus, restless legs syndrome, and lower dialysis adequacy (stdKt/V < 2.1).
More than half of maintenance hemodialysis patients had poor sleep quality as defined by the Pittsburgh Sleep Quality Index.
Older age was independently associated with poor sleep quality in maintenance hemodialysis patients.
Diabetes mellitus was independently associated with poor sleep quality in maintenance hemodialysis patients across multiple models.
Restless legs syndrome (RLS) was independently associated with poor sleep quality in maintenance hemodialysis patients.
Lower dialysis adequacy (stdKt/V < 2.1) was independently associated with poor sleep quality in maintenance hemodialysis patients.
Female sex was not independently associated with poor sleep quality after multivariable adjustment.
In an exploratory subgroup analysis of patients with diabetes mellitus, calcium-phosphorus product > 55 mg²/dL² was associated with poor sleep quality.
Dialysis vintage, residual urine volume, and weekly dialysis frequency were collected as variables but were not highlighted as significant independent predictors of poor sleep quality.
This research suggests that sleep problems are extremely common among people receiving maintenance hemodialysis (a kidney replacement therapy), with more than half of the 143 patients studied reporting poor sleep quality. The study, conducted at a single hospital in China between June and December 2024, used a standardized questionnaire called the Pittsburgh Sleep Quality Index to measure sleep quality and then looked for patient characteristics that were linked to sleeping poorly. The study found that four factors were most strongly linked to poor sleep: being older, having diabetes, having restless legs syndrome (an uncomfortable urge to move the legs at night), and having inadequate dialysis as measured by a value called stdKt/V falling below 2.1. Notably, inadequate dialysis remained a significant risk factor even after accounting for other variables, suggesting that optimizing how well dialysis clears waste products from the blood may be relevant to sleep quality. In a smaller exploratory analysis of only the diabetic patients, high levels of calcium and phosphorus in the blood (their product exceeding 55 mg²/dL²) were also associated with poor sleep, though this finding requires further investigation. This research suggests that poor sleep is a frequent and potentially under-recognized problem for people on hemodialysis, and that certain patient groups — particularly older patients, those with diabetes, and those with restless legs syndrome — may be at higher risk. The finding linking dialysis adequacy to sleep quality points to a potentially modifiable factor that clinicians might consider when addressing sleep complaints in this population. Because this was a single-center cross-sectional study, it cannot establish cause and effect, and the results may not apply to all hemodialysis patients worldwide.
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Upload Your LabsLiu X, Qu C, Tang N, Qi M, Wang J, Liu Y, et al.. (2026). Risk factors associated with poor sleep quality in maintenance hemodialysis patients: A single-center cross-sectional study.. Medicine. https://doi.org/10.1097/MD.0000000000048573