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Kronik Böbrek Hastalığı Olan Hastalarda Kötü Uyku Kalitesiyle İlgili Faktörlerin Böbrek Yetmezliğinin İlerlemesine Etkisi

Year 2020, Volume: 10 Issue: 4, 499 - 504, 30.12.2020
https://doi.org/10.16899/jcm.788100

Abstract

Amaç:
Son yıllarda, diyaliz öncesi KBH olan hastalarda uyku kalitesini karakterize etmek için sınırlı çalışmalar denenmiştir ve kanıtlar, yetersiz uyku süresinin veya düşük kaliteli uykunun KBH'nin ilerlemesine yol açtığını göstermiştir. Bu çalışmada kronik böbrek hastalarında kötü uyku kalitesi ile ilişkili faktörleri belirlemeyi ve bu faktörlerin böbrek progresyonu üzerindeki etkilerini değerlendirmeyi amaçladık.
Gereç ve yöntemler:
Çalışmaya kardiyovasküler hastalığı olmayan, obstrüktif uyku apnesi ve aktif enfeksiyonu olmayan 18 yaş ve üzeri prediyaliz KBH (Evre 3-5) hastalar alınarak Haziran 2015 - Kasım 2015 tarihleri arasında izlenmeye başlandı. Bu hastaların uyku kalitesi Pittsburgh uyku kalitesi indeksi (PUQI) kullanılarak ölçüldü. 4 yıllık takip sonunda hastaların birincil sonlanmaları ESRD, ESRD + mortalite ve progresyon (GFH'de 25 ml / dk azalma) olarak kabul edildi.
Bulgular:
Çalışmada izlenen 179 hastadan 107'si (% 59,8) iyi uyku kalitesine, 72'si (% 40,2) kötü uyku kalitesine sahipti. Kötü uyku kalitesinin bağımsız belirteçlerini tespit etmek için yapılan Binary Logistic Regression analizinde; yaşlılık ve kadın cinsiyetin kötü uyku kalitesinin bağımsız belirleyicisi olduğu bulundu. Kötü uyku kalitesinin ESRD, ESRD + Mortalite ve GFR≥ 25 ml / dk azalma gibi renal progresyon koşullarını etkilemediği bulundu.
Sonuç:
Sonuç olarak, yaş ve kadın cinsiyetin kötü uyku kalitesinin bağımsız belirleyicileri olduğunu ve kötü uyku kalitesinin mortaliteyi artırdığını belirledik.
Anahtar Kelimeler:
Uyku kalitesi, kronik böbrek hastalığı, progresyon

Supporting Institution

retrospektif çalışma

Project Number

approval no: 48929119/774.

References

  • Andrew S. Levey, Josef Coresh, National Kidney Foundation. K/DOQI clinical practice guidelines for chronic kidney disease: evaluation classification and stratification. Am J KidneyDis. 2002;39(2-1):S1–266.
  • Suleymanlar G, Utaş C, Arinsoy T et al. Apopulation-based survey of Chronic Renal Disease In Turkey the CREDIT study. Nephrol Dial Transplant. 2011 Jun;26(6):1862-71.
  • Jha V., Garcia-Garcia, G. Iseki, K. Li, Z. Naicker, S. Plattner, B. Saran, R. Wang, A.Y.M. and Yang C.W. 2013. Chronic kidney disease: global dimension and perspectives. The Lancet, 382(9888), pp.260-272.
  • Couser WG, Remuzzi G, Mendis S, Tonelli M. The contribution of chronic kidney disease to the global burden of major noncommunicable diseases. Kidney Int 2011;80:1258–70.
  • Gansevoort RT, Correa-Rotter R, Hemmelgarn BR, Jafar TH, Heerspink HJ, Mann JF, Matsushita K, Wen CP. Chronic kidney disease and cardiovascular risk: epidemiology mechanisms and prevention. Lancet. 2013; 382:339–352.
  • Wang F et al. Sleep duration and overweight/obesity in preschool-aged children: a prospective study of up to 48922 children of the Jiaxing Birth Cohort. Sleep. 2016;39(11):2013–2019.
  • Ogna A, Forni Ogna V, Haba Rubio J, et al. Sleep characteristics in early stages of chronic kidney disease in the HypnoLaus Cohort. Sleep. 2016;39:945–953.
  • Plantinga LC, Lee K, Stevens L, Saran R, Yee J, Gillespie B, et al. Association of sleep-related problems with chronic kidney disease in the United States, 2005-2008. Am J Kidney Dis. 2011;58(4):554–564.
  • Roumelioti ME, Buysse DJ, Sanders MH, Strollo P, Newman AB, Unruh ML. Sleep-disordered breathing and excessive daytime sleepiness in chronic kidney disease and hemodialysis. Clin J Am Soc Nephrol. 2011; 6:986–994.
  • Roumelioti ME, Buysse DJ, Sanders MH et al. Sleep apnea in patients on conventional thrice-weekly hemodialysis: comparison with matched controls from the Sleep Heart Health Study. J Am Soc Nephrol. 2006;17:3503–3509.
  • Unruh ML, Sanders MH, Redline S, Piraino BM, Umans JG, Chami H, Budhiraja R, Punjabi NM, Buysse D, Newman AB: Subjective and objective sleep quality in patients on conventional thrice-weekly hemodialysis: comparison with matched controls from the sleep heart health study. Am J Kidney Dis 2008;52:305–313.
  • Deng HB, Tam T, Zee BC, Chung RY, Su X, Jin L. et al. Short sleep duration increases metabolic impact in healthy adults: a population-based cohort study. Sleep 2017;40(10).
  • Hermann DM, Bassetti CL . Role of sleep-disordered breathing and sleep-wake disturbances for stroke and stroke recovery. Neurology 2016; 87: 1407–1416
  • Dutil C, Chaput JP. Inadequate sleep as a contributor to type 2 diabetes in children and adolescents. Nutr Diabetes. 2017;7:e266.
  • Petrov ME, Buman MP, Unruh ML, Baldwin CM, Jeong M, Reynaga-Ornelas L. et al. Association of sleep duration with kidney function and albuminuria: NHANES 2009–2012. Sleep Health. 2016;2:75–81.
  • Castro-Diehl C, et al. Sleep duration and quality in relation to autonomic nervous system measures: the multi-ethnic study of atherosclerosis (MESA). Sleep. 2016;39(11):1927–1940.
  • Yamamoto R, Nagasawa Y, Iwatani H, Shinzawa M, Obi Y et al. (2012) Self-reported sleep duration and prediction of proteinuria: a retrospective cohort study. Am J Kidney Dis 59: 343–355.
  • Brandenberger G, Follenius M, Goichot B, Saini J, Spiegel K, Ehrhart J, Simon C. Twenty-four-hour profiles of plasma renin activity in relation to the sleep-wake cycle. J Hypertens. 1994; 12: 277–283.
  • Charloux A, Gronfier C, Lonsdorfer-Wolf E, Piquard F, and Brandenberger G. Aldosterone release during the sleep-wake cycle in humans. Am J Physiol Endocrinol Metab 276: E43-E49, 1999
  • Kumar B, Tilea A, Gillespie BW, Zhang X, Kiser M, Eisele G, Finkelstein F, Kotanko P, Levin N, Rajagopalan S: Significance of self-reported sleep quality (SQ) in chronic kidney disease (CKD): the Renal Research Institute (RRI)-CKD study. Clin Nephrol 2010, 73:104–114.
  • Turek NF, Ricardo AC, Lash JP: Sleep disturbances as nontraditional risk factors for development and progression of CKD: review of the evidence. Am J Kidney Dis 2012, 60:823–833.
  • Iliescu EA, Yeates KE, Holland DC. Quality of sleep in patients with chronic kidney disease. Nephrol Dial Transplantation 2004;19:95-99.
  • Zhang J, Wang C, Gong W, et al. Association between sleep quality and cardiovascular damage in pre-dialysis patients with chronic kidney disease. BMC Nephrology 2014, 15:131.
  • Cohen SD, Patel SS, Khetpal P, et al. Pain, sleep disturbance, and quality of life in patients with chronic kidney disease. Clin J Am Soc Nephrol. 2007;2:919–925.
  • Ricardo AC, Knutson K, Chen J, Appel LJ, Bazzano L, CarmonaPowell E, Cohan J, Tamura MK, Steigerwalt S, Thornton JD, Weir M, Turek NF, Rahman M, Van Cauter E, Lash JP; Chronic Renal Insufficiency Cohort (CRIC) Study Investigators: The association of sleep duration and quality with CKD progression. J Am Soc Nephrol 28: 3708–3715, 2017
  • Perl J, Unruh ML, Chan CT: Sleep disorders in end-stage renal disease: Markers of inadequate dialysis’? Kidney Int 70: 1687–1693, 2006
  • Yamamoto R, Shinzawa M, Isaka Y, Yamakoshi E, Imai E, Ohashi Y, et al. Sleep Quality and Sleep Duration with CKD are Associated with Progression to ESKD. Clin J Am Soc Nephrol. 2018; 13 (12):1825–1832.
  • Shafi ST, Shafi T. A comparison of quality of sleep between patients with chronic kidney disease not on hemodialysis and end stage renal disease on hemodialysis in a developing country. Ren Fail 2017;39:623 28.
  • Kurella M, Luan J, Lash JP, et al. Self-assessed sleep quality in chronic kidney disease. Int Urol Nephrol. 2005;37:159–165
  • Grimaldi D, Carter JR, Van Cauter E, Leproult R: Adverse impact of sleep restriction and circadian misalignment on autonomic function in healthy young adults. Hypertension 68: 243–250, 2016
  • Lusardi P, Mugellini A, Preti P, Zoppi A, Derosa G, Fogari R: Effects of a restricted sleep regimen on ambulatory blood pressure monitoring in normotensive subjects. Am J Hypertens 9: 503–505, 1996
  • Tochikubo O, Ikeda A, Miyajima E, Ishii M: Effects of insufficient sleep on blood pressure monitored by a new multibiomedical recorder. Hypertension 27: 1318–1324, 1996
  • Spiegel K, Leproult R, Lhermite-Baleriaux M, Copinschi G, Penev PD, Van Cauter E: Leptin levels are dependent on sleep duration: Relationships with sympathovagal balance, carbohydrate regulation, cortisol, and thyrotropin. J Clin Endocrinol Metab 89: 5762–5771, 2004
  • Gangwisch JE, Heymsfield SB, Boden-Albala B, Buijs RM, Kreier F, Pickering TG, Rundle AG, Zammit GK, Malaspina D: Short sleep duration as a risk factor for hypertension: Analyses of the first national health and nutrition examination survey. Hypertension 47: 833–839, 2006
  • Cappuccio FP, D Elia L, Strazzullo P, Miller MA: Quantity and quality of sleep and incidence of type 2 diabetes: A systematic review and metaanalysis. Diabetes Care 33: 414–420, 2010
  • Knutson KL, Ryden AM, Mander BA, Van Cauter E: Role of sleep duration and quality in the risk and severity of type 2 diabetes mellitus. Arch Intern Med 166: 1768–1774, 2006
  • Ohayon M. Epidemiological study on insomnia in the general population Sleep 1996;19:7-15.
  • Sekercioglu N, Curtis B, Murphy S, Barrett B. Sleep quality and its correlates in Patients with chronic kidney disease: a cross-sectional design. Ren Fail. 2015 Jun;37(5):757-62.
  • Iliescu EA, Coo H, Mc Murray MH, Meers CL, Quinn MM, Singer MA, Hopman WM. Quality of sleep and health-related quality of life in haemodialysis patients. Nephrol Dial Transplant 2003; 18:126-132
  • Sabbatini M, Pisani A, Crispo A, et al. Sleep quality in patients with chronic renal failure: a three-year longitudinal study. Sleep Med 2008;9:240-246
  • Li J, Guo Q, Ye X, Lin J, Yi C, Mao H, Yang X, Yu X. Prevalence and risk factors of sleep disturbance in continuous ambulatory peritoneal dialysis patients in Guangzhou, southern China. Int Urol Nephrol. 2012 Jun;44(3):929-36.
  • Brancaccio D, Tetta C, Gallieni M, Panichi V. Inflammation CRP calcium overload and a high calcium phosphate product: a ‘‘liaison dangereuse’’. Nephrol Dial Transpl. 2002;17(2):201–203
  • Pecoits-Filho R, Lindholm B, Stenvinkel P Themal nutrition inflammation and atherosclerosis (MIA) syndrome—theheart of thematter. Nephrol Dial Transpl. 2002;17(Suppl 11):28–31
  • Combs SA, Teixeira JP, Germain MJ. Pruritus in Kidney Disease. Semin Nephrol. 2015 Jul;35(4):383-91
  • Pai MF, Hsu SP, Yang SY, Ho TI, Lai CF, Peng YS. Sleep disturbance in chronic hemodialysis patients: impact of depression and anemia. Ren Fail 2007;29(6):673-7.

The Effect of Factors Related to Poor Sleep Quality on Renal Failure Progression in Patients with Chronic Kidney Disease

Year 2020, Volume: 10 Issue: 4, 499 - 504, 30.12.2020
https://doi.org/10.16899/jcm.788100

Abstract

Aim:
In recent years, limited studies have been attempted to characterize the quality of sleep in patients with predialysis CKD, and the evidence has shown that insufficient sleep time or poor-quality sleep lead to the progression of CKD. In this study, we aimed to determine the factors related to poor sleep quality in chronic kidney patients and evaluate the effects of these factors on renal progression.
Materials and Methods:
Patients with pre-dialysis CKD (E3-E5) over 18 years of age who did not have cardiovascular disease, obstructive sleep apnea, and active infection, started to be followed between June 2015 and November 2015, were included in the study. The sleep quality of these patients was measured using the Pittsburgh sleep quality index (PSQI). At the end of the 4-year follow-up, the primary outcomes of the patients were accepted as ESRD, ESRD + mortality, and progression (25 ml/min reduction in GFR).
Results:
Of the 179 patients followed in the study, 107 (59.8%) had good sleep quality, 72 (40.2%) had poor sleep quality. In the Binary Logistic Regression analysis performed to detect independent markers of poor sleep quality; old age and female gender were found to be independent predictors of poor sleep quality. It was found that poor sleep quality did not affect renal progression conditions such as ESRD, ESRD + Mortality, and GFR≥ 25 ml/min decrease.
Conclusion:
As a result, we determined that age and female gender are independent determinants of poor sleep quality and poor sleep quality increases mortality.

Project Number

approval no: 48929119/774.

References

  • Andrew S. Levey, Josef Coresh, National Kidney Foundation. K/DOQI clinical practice guidelines for chronic kidney disease: evaluation classification and stratification. Am J KidneyDis. 2002;39(2-1):S1–266.
  • Suleymanlar G, Utaş C, Arinsoy T et al. Apopulation-based survey of Chronic Renal Disease In Turkey the CREDIT study. Nephrol Dial Transplant. 2011 Jun;26(6):1862-71.
  • Jha V., Garcia-Garcia, G. Iseki, K. Li, Z. Naicker, S. Plattner, B. Saran, R. Wang, A.Y.M. and Yang C.W. 2013. Chronic kidney disease: global dimension and perspectives. The Lancet, 382(9888), pp.260-272.
  • Couser WG, Remuzzi G, Mendis S, Tonelli M. The contribution of chronic kidney disease to the global burden of major noncommunicable diseases. Kidney Int 2011;80:1258–70.
  • Gansevoort RT, Correa-Rotter R, Hemmelgarn BR, Jafar TH, Heerspink HJ, Mann JF, Matsushita K, Wen CP. Chronic kidney disease and cardiovascular risk: epidemiology mechanisms and prevention. Lancet. 2013; 382:339–352.
  • Wang F et al. Sleep duration and overweight/obesity in preschool-aged children: a prospective study of up to 48922 children of the Jiaxing Birth Cohort. Sleep. 2016;39(11):2013–2019.
  • Ogna A, Forni Ogna V, Haba Rubio J, et al. Sleep characteristics in early stages of chronic kidney disease in the HypnoLaus Cohort. Sleep. 2016;39:945–953.
  • Plantinga LC, Lee K, Stevens L, Saran R, Yee J, Gillespie B, et al. Association of sleep-related problems with chronic kidney disease in the United States, 2005-2008. Am J Kidney Dis. 2011;58(4):554–564.
  • Roumelioti ME, Buysse DJ, Sanders MH, Strollo P, Newman AB, Unruh ML. Sleep-disordered breathing and excessive daytime sleepiness in chronic kidney disease and hemodialysis. Clin J Am Soc Nephrol. 2011; 6:986–994.
  • Roumelioti ME, Buysse DJ, Sanders MH et al. Sleep apnea in patients on conventional thrice-weekly hemodialysis: comparison with matched controls from the Sleep Heart Health Study. J Am Soc Nephrol. 2006;17:3503–3509.
  • Unruh ML, Sanders MH, Redline S, Piraino BM, Umans JG, Chami H, Budhiraja R, Punjabi NM, Buysse D, Newman AB: Subjective and objective sleep quality in patients on conventional thrice-weekly hemodialysis: comparison with matched controls from the sleep heart health study. Am J Kidney Dis 2008;52:305–313.
  • Deng HB, Tam T, Zee BC, Chung RY, Su X, Jin L. et al. Short sleep duration increases metabolic impact in healthy adults: a population-based cohort study. Sleep 2017;40(10).
  • Hermann DM, Bassetti CL . Role of sleep-disordered breathing and sleep-wake disturbances for stroke and stroke recovery. Neurology 2016; 87: 1407–1416
  • Dutil C, Chaput JP. Inadequate sleep as a contributor to type 2 diabetes in children and adolescents. Nutr Diabetes. 2017;7:e266.
  • Petrov ME, Buman MP, Unruh ML, Baldwin CM, Jeong M, Reynaga-Ornelas L. et al. Association of sleep duration with kidney function and albuminuria: NHANES 2009–2012. Sleep Health. 2016;2:75–81.
  • Castro-Diehl C, et al. Sleep duration and quality in relation to autonomic nervous system measures: the multi-ethnic study of atherosclerosis (MESA). Sleep. 2016;39(11):1927–1940.
  • Yamamoto R, Nagasawa Y, Iwatani H, Shinzawa M, Obi Y et al. (2012) Self-reported sleep duration and prediction of proteinuria: a retrospective cohort study. Am J Kidney Dis 59: 343–355.
  • Brandenberger G, Follenius M, Goichot B, Saini J, Spiegel K, Ehrhart J, Simon C. Twenty-four-hour profiles of plasma renin activity in relation to the sleep-wake cycle. J Hypertens. 1994; 12: 277–283.
  • Charloux A, Gronfier C, Lonsdorfer-Wolf E, Piquard F, and Brandenberger G. Aldosterone release during the sleep-wake cycle in humans. Am J Physiol Endocrinol Metab 276: E43-E49, 1999
  • Kumar B, Tilea A, Gillespie BW, Zhang X, Kiser M, Eisele G, Finkelstein F, Kotanko P, Levin N, Rajagopalan S: Significance of self-reported sleep quality (SQ) in chronic kidney disease (CKD): the Renal Research Institute (RRI)-CKD study. Clin Nephrol 2010, 73:104–114.
  • Turek NF, Ricardo AC, Lash JP: Sleep disturbances as nontraditional risk factors for development and progression of CKD: review of the evidence. Am J Kidney Dis 2012, 60:823–833.
  • Iliescu EA, Yeates KE, Holland DC. Quality of sleep in patients with chronic kidney disease. Nephrol Dial Transplantation 2004;19:95-99.
  • Zhang J, Wang C, Gong W, et al. Association between sleep quality and cardiovascular damage in pre-dialysis patients with chronic kidney disease. BMC Nephrology 2014, 15:131.
  • Cohen SD, Patel SS, Khetpal P, et al. Pain, sleep disturbance, and quality of life in patients with chronic kidney disease. Clin J Am Soc Nephrol. 2007;2:919–925.
  • Ricardo AC, Knutson K, Chen J, Appel LJ, Bazzano L, CarmonaPowell E, Cohan J, Tamura MK, Steigerwalt S, Thornton JD, Weir M, Turek NF, Rahman M, Van Cauter E, Lash JP; Chronic Renal Insufficiency Cohort (CRIC) Study Investigators: The association of sleep duration and quality with CKD progression. J Am Soc Nephrol 28: 3708–3715, 2017
  • Perl J, Unruh ML, Chan CT: Sleep disorders in end-stage renal disease: Markers of inadequate dialysis’? Kidney Int 70: 1687–1693, 2006
  • Yamamoto R, Shinzawa M, Isaka Y, Yamakoshi E, Imai E, Ohashi Y, et al. Sleep Quality and Sleep Duration with CKD are Associated with Progression to ESKD. Clin J Am Soc Nephrol. 2018; 13 (12):1825–1832.
  • Shafi ST, Shafi T. A comparison of quality of sleep between patients with chronic kidney disease not on hemodialysis and end stage renal disease on hemodialysis in a developing country. Ren Fail 2017;39:623 28.
  • Kurella M, Luan J, Lash JP, et al. Self-assessed sleep quality in chronic kidney disease. Int Urol Nephrol. 2005;37:159–165
  • Grimaldi D, Carter JR, Van Cauter E, Leproult R: Adverse impact of sleep restriction and circadian misalignment on autonomic function in healthy young adults. Hypertension 68: 243–250, 2016
  • Lusardi P, Mugellini A, Preti P, Zoppi A, Derosa G, Fogari R: Effects of a restricted sleep regimen on ambulatory blood pressure monitoring in normotensive subjects. Am J Hypertens 9: 503–505, 1996
  • Tochikubo O, Ikeda A, Miyajima E, Ishii M: Effects of insufficient sleep on blood pressure monitored by a new multibiomedical recorder. Hypertension 27: 1318–1324, 1996
  • Spiegel K, Leproult R, Lhermite-Baleriaux M, Copinschi G, Penev PD, Van Cauter E: Leptin levels are dependent on sleep duration: Relationships with sympathovagal balance, carbohydrate regulation, cortisol, and thyrotropin. J Clin Endocrinol Metab 89: 5762–5771, 2004
  • Gangwisch JE, Heymsfield SB, Boden-Albala B, Buijs RM, Kreier F, Pickering TG, Rundle AG, Zammit GK, Malaspina D: Short sleep duration as a risk factor for hypertension: Analyses of the first national health and nutrition examination survey. Hypertension 47: 833–839, 2006
  • Cappuccio FP, D Elia L, Strazzullo P, Miller MA: Quantity and quality of sleep and incidence of type 2 diabetes: A systematic review and metaanalysis. Diabetes Care 33: 414–420, 2010
  • Knutson KL, Ryden AM, Mander BA, Van Cauter E: Role of sleep duration and quality in the risk and severity of type 2 diabetes mellitus. Arch Intern Med 166: 1768–1774, 2006
  • Ohayon M. Epidemiological study on insomnia in the general population Sleep 1996;19:7-15.
  • Sekercioglu N, Curtis B, Murphy S, Barrett B. Sleep quality and its correlates in Patients with chronic kidney disease: a cross-sectional design. Ren Fail. 2015 Jun;37(5):757-62.
  • Iliescu EA, Coo H, Mc Murray MH, Meers CL, Quinn MM, Singer MA, Hopman WM. Quality of sleep and health-related quality of life in haemodialysis patients. Nephrol Dial Transplant 2003; 18:126-132
  • Sabbatini M, Pisani A, Crispo A, et al. Sleep quality in patients with chronic renal failure: a three-year longitudinal study. Sleep Med 2008;9:240-246
  • Li J, Guo Q, Ye X, Lin J, Yi C, Mao H, Yang X, Yu X. Prevalence and risk factors of sleep disturbance in continuous ambulatory peritoneal dialysis patients in Guangzhou, southern China. Int Urol Nephrol. 2012 Jun;44(3):929-36.
  • Brancaccio D, Tetta C, Gallieni M, Panichi V. Inflammation CRP calcium overload and a high calcium phosphate product: a ‘‘liaison dangereuse’’. Nephrol Dial Transpl. 2002;17(2):201–203
  • Pecoits-Filho R, Lindholm B, Stenvinkel P Themal nutrition inflammation and atherosclerosis (MIA) syndrome—theheart of thematter. Nephrol Dial Transpl. 2002;17(Suppl 11):28–31
  • Combs SA, Teixeira JP, Germain MJ. Pruritus in Kidney Disease. Semin Nephrol. 2015 Jul;35(4):383-91
  • Pai MF, Hsu SP, Yang SY, Ho TI, Lai CF, Peng YS. Sleep disturbance in chronic hemodialysis patients: impact of depression and anemia. Ren Fail 2007;29(6):673-7.
There are 45 citations in total.

Details

Primary Language English
Subjects Health Care Administration
Journal Section Original Research
Authors

Edip Erkuş 0000-0002-7821-8275

İbrahim Güney 0000-0002-1646-2811

Project Number approval no: 48929119/774.
Publication Date December 30, 2020
Acceptance Date September 21, 2020
Published in Issue Year 2020 Volume: 10 Issue: 4

Cite

AMA Erkuş E, Güney İ. The Effect of Factors Related to Poor Sleep Quality on Renal Failure Progression in Patients with Chronic Kidney Disease. J Contemp Med. December 2020;10(4):499-504. doi:10.16899/jcm.788100