Abstract: Objective  To investigate the influence of serum albumin changes on sleep quality and uremic pruritus in peritoneal dialysis (PD) patients.   Methods   Pittsburgh Sleep Quality Index (PSQI) and Four-Item Itch Questionnaire (FIIQ) were used to assess sleep quality and pruritus in the 166 PD patients regularly followed up in our PD center. Their clinical data and laboratory results were recruited. According to the changes of serum albumin level before PD (ALB0) and after PD (ALB1), the PD patients were divided into four groups: group A, normal albumin group (both ALB0 and ALB1 ≥35g/L); group B, elevated albumin group (ALB0＜35g/L, and ALB1≥35g/L); group C, persistent low protein group (both ALB0 and ALB1＜35g/L); group D, decreased albumin group (ALB0≥35g/L, and ALB1＜35g/L). Sleep disturbance, itching and other clinical parameters were compared among the groups.   Results   ①There were 63 patients in group A, 47 in group B, 38 in group C, and 18 in group D. Age (F=8.490, P＜0.001), dialysis duration (F=2.266, P=0.043), CRP (F=4.051, P=0.025) and the incidence of diabetes (χ²=28.160, P＜0.001) were significantly different among the four groups. ②The mean PSQI sleep score in group D was higher than that in group A (H=9.037, P=0.022) and group B (H=6.806, P=0.033); the mean PSQI sleep score in group C was higher than that in group A (H=3.269, P=0.049) and group B (H=3.503, P=0.045); the mean PSQI sleep score had no difference between group D and group C (H=23.458, P=0.459). The pruritus score in group D was significantly higher than that in groups A, B and C (P=0.001, 0.003 and 0.006 respectively). The incidence of sleep disorder in group D was 55.6%, significantly higher than that in groups A, B and C (P ＜0.05). The incidence of pruritus in group D was 64.7%, also significantly higher than that in groups A, B and C (P＜0.05). ③Logistic regression showed that decreased serum albumin after PD was an independent risk factor for pruritus (OR=3.886, 95% CI :1.132～13.333, P=0.031) and sleep disorder (OR=4.682, 95% CI 1.466～14.958, P=0.009).  Conclusion  ①PD patients with diabetes, older age, longer dialysis duration and micro-inflammatory state are prone to suffer from malnutrition or to negatively affect the nutritional status. ②Deterioration of nutritional status leads to the risk of sleep disorders and pruritus in PD patients.

Key words: Peritoneal dialysis, Nutritional status, Pruritus, Sleep disorder