Fatigue and Pruritus Impact Sleep Quality in Hemodialysis Patients

Overview

Journal Nat Sci Sleep

Publisher Dove Medical Press

Date 2025 Jan 6

PMID 39758161

Authors

Hayfa Almutary

Affiliations

Soon will be listed here.

Abstract

Purpose: This study assesses sleep quality amongst hemodialysis (HD) patients and identifies contributing factors, which include demographic and clinical factors and significant symptoms associated with HD (ie, fatigue and pruritus).

Patients And Methods: In this cross-sectional design, 116 participants were recruited from HD units of two hospitals in Saudi Arabia. Three measures were used to identify predictors of sleep quality among HD patients, including the Pittsburgh Sleep Quality Index (PSQI), the Fatigue Severity Scale (FSS), and the 5-D itch scale. Demographic and clinical profiles were also obtained. Univariate and multiple regression analyses were used to determine significant factors associated with sleep quality during HD.

Results: The mean global PSQI score was 6.77±3.23, with 56.9% of participants scoring 5 or more, indicating poor sleep. Sleep latency achieved the highest mean PSQI score (1.70 ±0.94), and 'use of sleep medication components' the lowest (0.36 ±0.83). Increased age, lower educational status, higher fatigue, and pruritus were associated with poorer sleep. Controlling for status and age suggested that fatigue and pruritus independently influenced HD patients' sleep quality ( (4, 111) = 10.89, = <0.001). There were positive relationships between increased levels of fatigue and pruritus and poor quality of sleep.

Conclusion: This is the first study to examine fatigue, pruritus, and sleep quality in HD patients. Findings will assist dialysis clinicians to develop appropriate management strategies to mitigate factors causing poor sleep for such patients. Intervention programs targeting self-management of fatigue and pruritus symptoms could potentially improve patients' sleep quality.

References

Agarwal R, Burton J, Gallieni M, Kalantar-Zadeh K, Mayer G, Pollock C . Alleviating symptoms in patients undergoing long-term hemodialysis: a focus on chronic kidney disease-associated pruritus. Clin Kidney J. 2023; 16(1):30-40. PMC: 9871858. DOI: 10.1093/ckj/sfac187. View

Khan T, Al-Haider I, Syed Sulaiman S, Hassali M . Linguistic validation of the 5D itching scale to Arabic in patients with end-stage kidney disease. J Ren Care. 2013; 39(4):222-7. DOI: 10.1111/j.1755-6686.2013.12038.x. View

Buysse D, Reynolds 3rd C, Monk T, BERMAN S, Kupfer D . The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research. Psychiatry Res. 1989; 28(2):193-213. DOI: 10.1016/0165-1781(89)90047-4. View

Rehman I, Lai P, Lim S, Lee L, Khan T . Sleep disturbance among Malaysian patients with end-stage renal disease with pruritus. BMC Nephrol. 2019; 20(1):102. PMC: 6434782. DOI: 10.1186/s12882-019-1294-1. View

Velu S, Rajagopalan A, Arunachalam J, Prasath A, Durai R . Subjective Assessment of Sleep Quality and Excessive Daytime Sleepiness in Conventional Hemodialysis Population: A Single-Center Experience. Int J Nephrol Renovasc Dis. 2022; 15:103-114. PMC: 8932937. DOI: 10.2147/IJNRD.S351515. View

Elman S, Hynan L, Gabriel V, Mayo M . The 5-D itch scale: a new measure of pruritus. Br J Dermatol. 2009; 162(3):587-93. PMC: 2875190. DOI: 10.1111/j.1365-2133.2009.09586.x. View

Davies S, Phillips L, Naish P, Russell G . Quantifying comorbidity in peritoneal dialysis patients and its relationship to other predictors of survival. Nephrol Dial Transplant. 2002; 17(6):1085-92. DOI: 10.1093/ndt/17.6.1085. View

Shahin W, Kennedy G, Stupans I . The impact of personal and cultural beliefs on medication adherence of patients with chronic illnesses: a systematic review. Patient Prefer Adherence. 2019; 13:1019-1035. PMC: 6611718. DOI: 10.2147/PPA.S212046. View

Parvan K, Lakdizaji S, Roshangar F, Mostofi M . Quality of sleep and its relationship to quality of life in hemodialysis patients. J Caring Sci. 2014; 2(4):295-304. PMC: 4134147. DOI: 10.5681/jcs.2013.035. View

10.

Zhou X, Liu Y, Zhang X, Wang C, Liu S, Jiang Y . Global prevalence of restless legs syndrome among hemodialysis patients: A systematic review and meta-analysis. Brain Behav. 2024; 14(1):e3378. PMC: 10784193. DOI: 10.1002/brb3.3378. View

11.

Kir S, Kirhan I, Dilek M . Prevalence of Sleep Disorders and Related Factors in Individuals Undergoing Hemodialysis. Cogn Behav Neurol. 2021; 34(3):161-169. DOI: 10.1097/WNN.0000000000000278. View

12.

Al-Sobayel H, Al-Hugail H, AlSaif R, Albawardi N, Alnahdi A, Daif A . Validation of an Arabic version of Fatigue Severity Scale. Saudi Med J. 2016; 37(1):73-8. PMC: 4724683. DOI: 10.15537/smj.2016.1.13055. View

13.

Daraghmeh M, Badran M, Janajreh A, Hassan M, Taha A, Koni A . Prevalence of pruritus associated with hemodialysis and its association with sleep quality among hemodialysis patients: a multicenter study. BMC Nephrol. 2022; 23(1):213. PMC: 9205133. DOI: 10.1186/s12882-022-02838-z. View

14.

Brekke F, Waldum B, Amro A, Osthus T, Dammen T, Gudmundsdottir H . Self-perceived quality of sleep and mortality in Norwegian dialysis patients. Hemodial Int. 2013; 18(1):87-94. DOI: 10.1111/hdi.12066. View

15.

Sukul N, Karaboyas A, Csomor P, Schaufler T, Wen W, Menzaghi F . Self-reported Pruritus and Clinical, Dialysis-Related, and Patient-Reported Outcomes in Hemodialysis Patients. Kidney Med. 2021; 3(1):42-53.e1. PMC: 7873756. DOI: 10.1016/j.xkme.2020.08.011. View

16.

Mathur V, Lindberg J, Germain M, Block G, Tumlin J, Smith M . A longitudinal study of uremic pruritus in hemodialysis patients. Clin J Am Soc Nephrol. 2010; 5(8):1410-9. PMC: 2924419. DOI: 10.2215/CJN.00100110. View

17.

Nelson K, Davis J, Corbett C . Sleep quality: An evolutionary concept analysis. Nurs Forum. 2021; 57(1):144-151. DOI: 10.1111/nuf.12659. View

18.

Krupp L, Larocca N, Steinberg A . The fatigue severity scale. Application to patients with multiple sclerosis and systemic lupus erythematosus. Arch Neurol. 1989; 46(10):1121-3. DOI: 10.1001/archneur.1989.00520460115022. View

19.

Einollahi B, Motalebi M, Rostami Z, Nemati E, Salesi M . Sleep quality among Iranian hemodialysis patients: a multicenter study. Nephrourol Mon. 2015; 7(1):e23849. PMC: 4330687. DOI: 10.5812/numonthly.23849. View

20.

Elder S, Pisoni R, Akizawa T, Fissell R, Andreucci V, Fukuhara S . Sleep quality predicts quality of life and mortality risk in haemodialysis patients: results from the Dialysis Outcomes and Practice Patterns Study (DOPPS). Nephrol Dial Transplant. 2007; 23(3):998-1004. DOI: 10.1093/ndt/gfm630. View