关键词: 维持性血液透析, 慢性肾脏病, 睡眠障碍, 危险因素, C反应蛋白

Abstract: Objective  This study aimed to investigate the sleep status of maintenance hemodialysis (MHD) patients and explore its influencing factors, to provide a scientific basis for developing targeted interventions to improve sleep quality, and to offer data support for real-world research. Methods  A total of 346 MHD patients treated at multiple hemodialysis centers in Luoyang city between June 2023 and March 2024 were enrolled. Patients were divided into a no-sleep-disorder group and a sleep-disorder group based on their total Pittsburgh Sleep Quality Index (PSQI) score. Standardized questionnaires were used to collect demographic and socio-economic information. Laboratory indicators from the 3 months prior to enrollment, including intact Parathyroid Hormone (iPTH) and C-reactive protein (CRP), were extracted from the electronic medical record system. Differences in indicators between the two groups were compared. Spearman correlation analysis was used to assess the correlation between indicators and sleep disorder occurrence. Multivariate logistic regression models were employed to identify independent risk factors for sleep disorders.  Results  The prevalence of sleep disorders among MHD patients was 75.2% (260/346). Univariate analysis identified significant associations between the two groups in age, type of medical insurance,dialysis vintage, commodities (diabetes,cardiovascular/cerebrovascular diseases), and iPTH and CRP levels (all P＜0.05). Further Spearman correlation analysis showed that patient age (r=0.233, P＜0.001), dialysis vintage (r=0.130, P=0.021), presence of diabetes (r=0.153, P=0.006), presence of cardiovascular/cerebrovascular diseases (r=0.235, P＜0.001), and CRP level (r=0.216, P＜0.001) were significantly positively correlated with sleep disorders (all P＜0.05). Multivariate logistic regression analysis indicated that MHD patient age (OR=1.021, 95% CI: 1.001～1.041, P=0.036), dialysis vintage (OR=1.006, 95% CI: 1.001～1.012, P=0.028), presence of diabetes (OR=1.971, 95% CI:1.127～3.447, P=0.017), and CRP level (OR=1.027, 95% CI: 1.003～1.051, P=0.024) were independent risk factors for sleep disorders (all P＜0.05).   Conclusion  This study found a high prevalence of sleep disorders (75.2%) among MHD patients. Advanced age, longer dialysis vintage, presence of diabetes, and elevated CRP levels were confirmed as independent risk factors. Therefore, special attention is needed in clinical practice for MHD patients who are older, have a longer dialysis vintage, and have underlying comorbidities. Actively managing underlying conditions and conducting regular monitoring may help reduce the incidence of sleep disorders in MHD patients, thereby effectively improving their prognosis and quality of life.

Key words: Maintenance hemodialysis, Chronic kidney disease, Sleep disorders, Risk factors, C-reactive protein