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Hemodiyaliz hastalarında uyku kalitesi ile inflamatuvar ve biyokimyasal parametreler arasındaki ilişki

Year 2025, Volume: 7 Issue: 5, 613 - 617, 15.09.2025
https://doi.org/10.38053/acmj.1739247

Abstract

Amaç: Bu çalışmada, hemodiyaliz hastalarında uyku kalitesi ile inflamatuvar ve biyokimyasal parametreler arasındaki ilişki değerlendirildi.
Yöntem: Ocak 2025’te tek merkezli olarak yürütülen kesitsel çalışmaya, en az altı aydır hemodiyaliz tedavisi gören, 18 yaş ve üzeri toplam 195 hasta dahil edildi. Uyku kalitesi Pittsburgh Uyku Kalitesi İndeksi (PUKİ) ile ölçüldü; PUKİ ≤5 “iyi uyku”, PUKİ >5 “kötü uyku” olarak gruplandırıldı. Demografik, klinik ve laboratuvar verileri retrospektif olarak toplandı. Tek değişkenli analiz karşılaştırmaların ardından kötü uyku kalitesinin bağımsız belirleyicilerini saptamak için lojistik regresyon analizi gerçekleştirildi.
Bulgular: Hastaların %55’inde kötü uyku kalitesi saptandı. Univaryant analizde kötü uyuyanlarda CRP, lökosit, CRP/Albümin oranı yüksek; hemoglobin, albümin ve HALP skoru düşük bulundu (p<0,05). Çoklu lojistik regresyon modeli, artmış CRP (OR 1,032; %95 GA 1,001–1,064; p=0,043) ve düşük hemoglobin düzeyinin (OR 0,481; %95 GA 0,350–0,660; p<0,001) kötü uyku kalitesinin bağımsız belirleyicileri olduğunu gösterdi.
Sonuç: Hemodiyaliz hastalarında uyku bozuklukları, sistemik inflamasyon ve anemiyle yakından ilişkili olup, CRP ve hemoglobin düzeyleri kötü uyku kalitesinin güçlü bağımsız belirleyicileridir. Klinik uygulamada bu parametrelerin rutin izlenmesi ve inflamasyon ile anemiyi hedef alan müdahalelerin geliştirilmesi önerilir.

References

  • Seyahi N, Kocyigit İ, Eren N, et al. Current status of kidney replacement therapy in Turkiye: a summary of 2022 Turkish Society of Nephrology registry report. Turk J Nephrol. 2024;33(2):134-139. doi:10.5152/turkjnephrol.2025.24978
  • Pawar YS, Gattani VS, Chaudhari KS, Chheda B, Vankudre AJ. Impact of hemodialysis on sleep disorders in patients with end-stage renal disease in a tertiary care academic hospital. Cureus. 2023;15(8):e44416. doi:10.7759/cureus.44416
  • Ezzat H, Mohab A. Prevalence of sleep disorders among ESRD patients. Ren Fail. 2015;37(6):1013-1019. doi:10.3109/0886022X.2015.1044401
  • Iliescu EA, Coo H, McMurray MH, et al. Quality of sleep and health-related quality of life in haemodialysis patients. Nephrol Dial Transplant. 2003;18(1):126-132. doi:10.1093/ndt/18.1.126
  • Belluardo G, Sessa C, Morale W. The alterations of sleep and frontal functions in chronic hemodialysis: pathogenesis and therapeutic perspectives. Behav Brain Res. 2025;478:115337. doi:10.1016/j.bbr.2024. 115337
  • Turgay G, Tutal E, Sezer S. Restless legs syndrome, sleep quality and fatigue in hemodialysis patients. Turk Neph Dial Transplant. 2018;27(2): 196-203.
  • Elder SJ, Pisoni RL, Akizawa T, et al. 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. 2008;23(3):998-1004. doi:10.1093/ndt/gfm630
  • Russcher M, Chaves I, Lech K, et al. An observational study on disturbed peripheral circadian rhythms in hemodialysis patients. Chronobiol Int. 2015;32(6):848-857. doi:10.3109/07420528.2015.1048868
  • Razeghi E, Sahraian MA, Heidari R, Bagherzadeh M. Association of inflammatory biomarkers with sleep disorders in hemodialysis patients. Acta Neurol Belg. 2012;112(1):45-49. doi:10.1007/s13760-012-0003-7
  • Buysse DJ, Reynolds CF, 3rd, Monk TH, Berman SR, Kupfer DJ. 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
  • Ağargün MY, Kara H, Anlar Ö. Pittsburgh uyku kalitesi indeksinin geçerligi ve güvenirligi. Turk Psikiyatri Dergisi. 1996;7:107-115.
  • Farag CM, Antar R, Akosman S, Ng M, Whalen MJ. What is hemoglobin, albumin, lymphocyte, platelet (HALP) score? A comprehensive literature review of HALP's prognostic ability in different cancer types. Oncotarget. 2023;14:153-172. doi:10.18632/oncotarget.28367
  • Zhang F, Li L, Shi T, Liu Y, Xie J, Yu L. The hemoglobin, albumin, lymphocyte, and platelet (HALP) is a potent indicator for the prognosis in hemodialysis patients. Medicine (Baltimore). 2023;102(19):e33650. doi:10.1097/MD.0000000000033650
  • Babovic B, Belada Babovic N, Tomovic F, et al. The importance of biochemical parameters, immunonutritional status, and social support for quality of life in chronic hemodialysis patients. Medicina (Kaunas). 2024;60(11):1751. doi:10.3390/medicina60111751
  • Merlino G, Piani A, Dolso P, et al. Sleep disorders in patients with end-stage renal disease undergoing dialysis therapy. Nephrol Dial Transplant. 2006;21(1):184-190. doi:10.1093/ndt/gfi144
  • Alshammari B, Alkubati SA, Pasay-An E, et al. Sleep quality and its affecting factors among hemodialysis patients: a multicenter cross-sectional study. Healthcare (Basel). 2023;11(18):2536. doi:10.3390/healthcare11182536
  • Masoumi M, Naini AE, Aghaghazvini R, Amra B, Gholamrezaei A. Sleep quality in patients on maintenance hemodialysis and peritoneal dialysis. Int J Prev Med. 2013;4(2):165-172.
  • Chiu YL, Chuang YF, Fang KC, et al. Higher systemic inflammation is associated with poorer sleep quality in stable haemodialysis patients. Nephrol Dial Transplant. 2009;24(1):247-251. doi:10.1093/ndt/gfn439
  • Taraz M, Khatami MR, Hajiseyedjavadi M, et al. Association between antiinflammatory cytokine, IL-10, and sleep quality in patients on maintenance hemodialysis. Hemodial Int. 2013;17(3):382-390. doi:10. 1111/hdi.12035
  • Neumann SN, Li JJ, Yuan XD, et al. Anemia and insomnia: a cross-sectional study and meta-analysis. Chin Med J (Engl). 2020;134(6):675-681. doi:10.1097/CM9.0000000000001306
  • Ghahremanfard F, Semnani MR, Mirmohammadkhani M, et al. The relationship between iron deficiency anemia with restless leg syndrome and sleep quality in workers working in a textile factory in Iran: a cross-sectional study. Middle East Curr Psychiatry. 2023;30(1):23. doi:10.1186/s43045-023-00294-5
  • Liu R, Liu X, Zee PC, et al. Association between sleep quality and C-reactive protein: results from national health and nutrition examination survey, 2005-2008. PLoS ONE 2014;9(3):e92607. doi:10. 1371/journal.pone.0092607

The relationshop between sleep quality and inflammatory and biochemical parameters in hemodialysis patients

Year 2025, Volume: 7 Issue: 5, 613 - 617, 15.09.2025
https://doi.org/10.38053/acmj.1739247

Abstract

Aims: This study aimed to evaluate the relationship between sleep quality and inflammatory and biochemical parameters in hemodialysis patients.
Methods: In this cross-sectional, single-center study conducted in January 2025, a total of 195 patients aged 18 and older who had been undergoing hemodialysis treatment for at least six months were included. Sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI); scores ≤5 were classified as “good sleep,” and >5 as “poor sleep.” Demographic, clinical, and laboratory data were retrospectively collected. Following univariate comparisons, logistic regression analysis was performed to determine independent predictors of poor sleep quality.
Results: Poor sleep quality was observed in 55% of the patients. In the univariate analysis, CRP, leukocytes, and CRP/albumin ratio were higher in poor sleepers, while hemoglobin, albumin, and HALP scores were lower (p<0.05). Multivariate logistic regression analysis revealed that elevated CRP (OR 1.032; 95% CI 1.001–1.064; p=0.043) and low hemoglobin (OR 0.481; 95% CI 0.350–0.660; p<0.001) were independent predictors of poor sleep quality.
Conclusion: Sleep disorders in hemodialysis patients are closely associated with systemic inflammation and anemia. CRP and hemoglobin levels are strong independent determinants of poor sleep quality. It is recommended that these parameters be routinely monitored in clinical practice and that interventions targeting inflammation and anemia be developed.

Ethical Statement

The study was approved by the Ethics Committee of Etlik City Hospital on 18.12.2024 (Decision No: AEŞH-BADEK-2024-1230) and conducted in accordance with the Declaration of Helsinki. Written informed consent was obtained from all participants

References

  • Seyahi N, Kocyigit İ, Eren N, et al. Current status of kidney replacement therapy in Turkiye: a summary of 2022 Turkish Society of Nephrology registry report. Turk J Nephrol. 2024;33(2):134-139. doi:10.5152/turkjnephrol.2025.24978
  • Pawar YS, Gattani VS, Chaudhari KS, Chheda B, Vankudre AJ. Impact of hemodialysis on sleep disorders in patients with end-stage renal disease in a tertiary care academic hospital. Cureus. 2023;15(8):e44416. doi:10.7759/cureus.44416
  • Ezzat H, Mohab A. Prevalence of sleep disorders among ESRD patients. Ren Fail. 2015;37(6):1013-1019. doi:10.3109/0886022X.2015.1044401
  • Iliescu EA, Coo H, McMurray MH, et al. Quality of sleep and health-related quality of life in haemodialysis patients. Nephrol Dial Transplant. 2003;18(1):126-132. doi:10.1093/ndt/18.1.126
  • Belluardo G, Sessa C, Morale W. The alterations of sleep and frontal functions in chronic hemodialysis: pathogenesis and therapeutic perspectives. Behav Brain Res. 2025;478:115337. doi:10.1016/j.bbr.2024. 115337
  • Turgay G, Tutal E, Sezer S. Restless legs syndrome, sleep quality and fatigue in hemodialysis patients. Turk Neph Dial Transplant. 2018;27(2): 196-203.
  • Elder SJ, Pisoni RL, Akizawa T, et al. 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. 2008;23(3):998-1004. doi:10.1093/ndt/gfm630
  • Russcher M, Chaves I, Lech K, et al. An observational study on disturbed peripheral circadian rhythms in hemodialysis patients. Chronobiol Int. 2015;32(6):848-857. doi:10.3109/07420528.2015.1048868
  • Razeghi E, Sahraian MA, Heidari R, Bagherzadeh M. Association of inflammatory biomarkers with sleep disorders in hemodialysis patients. Acta Neurol Belg. 2012;112(1):45-49. doi:10.1007/s13760-012-0003-7
  • Buysse DJ, Reynolds CF, 3rd, Monk TH, Berman SR, Kupfer DJ. 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
  • Ağargün MY, Kara H, Anlar Ö. Pittsburgh uyku kalitesi indeksinin geçerligi ve güvenirligi. Turk Psikiyatri Dergisi. 1996;7:107-115.
  • Farag CM, Antar R, Akosman S, Ng M, Whalen MJ. What is hemoglobin, albumin, lymphocyte, platelet (HALP) score? A comprehensive literature review of HALP's prognostic ability in different cancer types. Oncotarget. 2023;14:153-172. doi:10.18632/oncotarget.28367
  • Zhang F, Li L, Shi T, Liu Y, Xie J, Yu L. The hemoglobin, albumin, lymphocyte, and platelet (HALP) is a potent indicator for the prognosis in hemodialysis patients. Medicine (Baltimore). 2023;102(19):e33650. doi:10.1097/MD.0000000000033650
  • Babovic B, Belada Babovic N, Tomovic F, et al. The importance of biochemical parameters, immunonutritional status, and social support for quality of life in chronic hemodialysis patients. Medicina (Kaunas). 2024;60(11):1751. doi:10.3390/medicina60111751
  • Merlino G, Piani A, Dolso P, et al. Sleep disorders in patients with end-stage renal disease undergoing dialysis therapy. Nephrol Dial Transplant. 2006;21(1):184-190. doi:10.1093/ndt/gfi144
  • Alshammari B, Alkubati SA, Pasay-An E, et al. Sleep quality and its affecting factors among hemodialysis patients: a multicenter cross-sectional study. Healthcare (Basel). 2023;11(18):2536. doi:10.3390/healthcare11182536
  • Masoumi M, Naini AE, Aghaghazvini R, Amra B, Gholamrezaei A. Sleep quality in patients on maintenance hemodialysis and peritoneal dialysis. Int J Prev Med. 2013;4(2):165-172.
  • Chiu YL, Chuang YF, Fang KC, et al. Higher systemic inflammation is associated with poorer sleep quality in stable haemodialysis patients. Nephrol Dial Transplant. 2009;24(1):247-251. doi:10.1093/ndt/gfn439
  • Taraz M, Khatami MR, Hajiseyedjavadi M, et al. Association between antiinflammatory cytokine, IL-10, and sleep quality in patients on maintenance hemodialysis. Hemodial Int. 2013;17(3):382-390. doi:10. 1111/hdi.12035
  • Neumann SN, Li JJ, Yuan XD, et al. Anemia and insomnia: a cross-sectional study and meta-analysis. Chin Med J (Engl). 2020;134(6):675-681. doi:10.1097/CM9.0000000000001306
  • Ghahremanfard F, Semnani MR, Mirmohammadkhani M, et al. The relationship between iron deficiency anemia with restless leg syndrome and sleep quality in workers working in a textile factory in Iran: a cross-sectional study. Middle East Curr Psychiatry. 2023;30(1):23. doi:10.1186/s43045-023-00294-5
  • Liu R, Liu X, Zee PC, et al. Association between sleep quality and C-reactive protein: results from national health and nutrition examination survey, 2005-2008. PLoS ONE 2014;9(3):e92607. doi:10. 1371/journal.pone.0092607
There are 22 citations in total.

Details

Primary Language English
Subjects Nefroloji
Journal Section Research Articles
Authors

Arzu Akgül 0009-0007-8119-3893

Neriman Sıla Koç 0000-0002-4654-9002

Berrak Itır Aylı 0000-0002-0834-900X

Hakkı Öztürk 0000-0002-1600-5637

Mehmet Deniz Aylı 0000-0003-3145-1595

Publication Date September 15, 2025
Submission Date July 10, 2025
Acceptance Date August 22, 2025
Published in Issue Year 2025 Volume: 7 Issue: 5

Cite

AMA Akgül A, Koç NS, Aylı BI, Öztürk H, Aylı MD. The relationshop between sleep quality and inflammatory and biochemical parameters in hemodialysis patients. Anatolian Curr Med J / ACMJ / acmj. September 2025;7(5):613-617. doi:10.38053/acmj.1739247

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