Prevalence and risk factors of sleep disturbance in continuous ambulatory peritoneal dialysis patients in Guangzhou, southern China

Demographic and clinical risk factors for diagnosis of sleep disorders in ESRD patients

BACKGROUND

Sleep disturbances in patients with end-stage renal disease (ESRD) are common and more prevalent than in the general population. This study aims to assess the demographic and clinical risk factors for the diagnosis of sleep disorders in ESRD patients.

METHODS

This study is a retrospective analysis of the United States Renal Data System (USRDS) to evaluate risk factors for the diagnosis of sleep disorders, including hypersomnolence, insomnia, restless leg syndrome (RLS), or obstructive or central sleep apnea (OSA/CSA). All ESRD subjects enrolled in the USRDS between 2004-2015 were eligible for inclusion. The risk factors analyzed were age, race, sex, ethnicity, access type, dialysis modality, and the Charlson Comorbidity Index (CCI). All statistical analysis was performed using SAS 9.4, and statistical significance was assessed using an alpha level of 0.05. Descriptive statistics on all variables overall and by each sleep diagnosis were determined.

RESULTS

Increasing age, black race, other race, and Hispanic ethnicity were associated with decreased risk of each sleep diagnosis while CCI was associated with increased risk. Females were at increased risk of RLS and insomnia while males were at increased risk of OSA/CSA. Catheter and graft access decreased risk of RLS but increased risk of insomnia compared to AVF access. Catheter access increased risk of OSA/CSA compared to graft access. Hemodialysis increased risk of OSA/CSA compared to peritoneal dialysis.

CONCLUSIONS

Some ESRD patients are at an increased risk for diagnosis of sleep disorders based on age, race, sex, comorbid health conditions, and dialysis modality.

Nurse-based educational interventions in patients with peritoneal dialysis: A systematic review and meta-analysis

Background

Peritoneal dialysis (PD) is a major renal replacement therapy modality for patients with end-stage kidney disease (ESKD) worldwide. As poor self-care of PD patients could lead to serious complications, including peritonitis, exit-site infection, technique failure, and death; several nurse-based educational interventions have been introduced. However, these interventions varied and have been supported by small-scale studies so the effectiveness of nurse-based educational interventions on clinical outcomes of PD patients has been inconclusive.

Objectives

To evaluate the effectiveness of nurse-based education interventions in PD patients.

Design

A systematic review and meta-analysis of Randomized Controlled Trials (RCTs).

Methods

We performed a systematic search using PubMed, Embase, and CENTRAL up to December 31, 2021. Selection criteria included Randomized Controlled Trials (RCTs) relevant to nurse-based education interventions in ESKD patients with PD in the English language. The meta-analyses were conducted using a random-effects model to evaluate the summary outcomes of peritonitis, PD-related infection, mortality, transfer to hemodialysis, and quality of life (QoL).

Results

From 9,816 potential studies, 71 theme-related abstracts were selected for further full-text articles screening against eligibility criteria. As a result, eleven studies (1,506 PD patients in seven countries) were included in our systematic review. Of eleven studies, eight studies (1,363 PD patients in five countries) were included in the meta-analysis. Sleep QoL in the intervention group was statistically significantly higher than control (mean difference = 12.76, 95% confidence intervals 5.26-20.27). There was no difference between intervention and control groups on peritonitis, PD-related infection, HD transfer, and overall QoL.

Conclusions

Nurse-based educational interventions could help reduce some PD complications, of which only the sleep QoL showed statistically significant improvement. High-quality evidence on the nurse-based educational interventions was limited and more RCTs are needed to provide more robust outcomes.

Tweetable abstract

Nurse-based educational interventions showed promising sleep quality improvement and potential peritonitis risk reduction among PD patients.

Prevalence and risk factors of poor sleep quality in continuous ambulatory peritoneal dialysis patients in Nanchang, Southeast China

This study aimed to explore the prevalence and risk factors of poor sleep quality in patients undergoing continuous ambulatory peritoneal dialysis (CAPD) at the peritoneal dialysis center of the First Affiliated Hospital of Nanchang University. This cross-sectional study was conducted from March 2019 to December 2019. The Pittsburgh Sleep Quality Index (PSQI) was used to evaluate the sleep quality of patients undergoing CAPD. A PSQI score of ≥5 was defined as poor sleep quality, whereas a PSQI of <5 was defined as good sleep quality. Logistic regression analysis was used to analyze risk factors for poor sleep quality. In total, 456 patients undergoing CAPD were investigated. The average PSQI score was 5.0 ± 2.9. Among the participants, 46.3% had poor sleep quality, and 45.6% were female patients. The average age was 49.4 ± 13.3 years. Compared with good sleepers, poor sleepers included a higher proportion of females and calcium–phosphorus (Ca × P) product, longer dialysis durations, lower total endogenous creatinine clearance rates, less residual renal function, and lower albumin levels. Multivariate logistic regression analysis showed that a long dialysis duration, low albumin level, and high Ca × P product were independent risk factors for poor sleep quality in patients undergoing CAPD. Odds ratios (95% confidence interval) for these risk factors were 1.01 (1.00–1.02), 0.95 (0.91–1.00), and 1.02 (1.00–1.03), respectively. Interventions aimed at improving albumin and Ca × P product levels may improve quality of life for CAPD patients.

Epidemiology of peritoneal dialysis outcomes

Peritoneal dialysis (PD) is an important home-based treatment for kidney failure and accounts for 11% of all dialysis and 9% of all kidney replacement therapy globally. Although PD is available in 81% of countries, this provision ranges from 96% in high-income countries to 32% in low-income countries. Compared with haemodialysis, PD has numerous potential advantages, including a simpler technique, greater feasibility of use in remote communities, generally lower cost, lesser need for trained staff, fewer management challenges during natural disasters, possibly better survival in the first few years, greater ability to travel, fewer dietary restrictions, better preservation of residual kidney function, greater treatment satisfaction, better quality of life, better outcomes following subsequent kidney transplantation, delayed need for vascular access (especially in small children), reduced need for erythropoiesis-stimulating agents, and lower risk of blood-borne virus infections and of SARS-CoV-2 infection. PD outcomes have been improving over time but with great variability, driven by individual and system-level inequities and by centre effects; this variation is exacerbated by a lack of standardized outcome definitions. Potential strategies for outcome improvement include enhanced standardization, monitoring and reporting of PD outcomes, and the implementation of continuous quality improvement programmes and of PD-specific interventions, such as incremental PD, the use of biocompatible PD solutions and remote PD monitoring.

The use of peritoneal dialysis (PD) can be advantageous compared with haemodialysis treatment, although several barriers limit its broad implementation. This review examines the epidemiology of peritoneal dialysis (PD) outcomes, including clinical, patient-reported and surrogate PD outcomes.

Peritoneal dialysis (PD) has distinct advantages compared with haemodialysis, including the convenience of home treatment, improved quality of life, technical simplicity, lesser need for trained staff, greater cost-effectiveness in most countries, improved equity of access to dialysis in resource-limited settings, and improved survival, particularly in the first few years of initiating therapy.

Important barriers can hamper PD utilization in low-income settings, including the high costs of PD fluids (owing to the inability to manufacture them locally and the exorbitant costs of their import), limited workforce availability and a practice culture that limits optimal PD use, often leading to suboptimal outcomes.

PD outcomes are highly variable around the world owing in part to the use of variable outcome definitions, a heterogeneous practice culture, the lack of standardized monitoring and reporting of quality indicators, and kidney failure care gaps (including health care workforce shortages, inadequate health care financing, suboptimal governance and a lack of good health care information systems).

Key outcomes include not only clinical outcomes (typically defined as medical outcomes based on clinician assessment or diagnosis) — for example, PD-related infections, technique survival, mechanical complications, hospitalizations and PD-related mortality — but also patient-reported outcomes. These outcomes are directly reported by patients and focus on how they function or feel, typically in relation to quality of life or symptoms; patient-reported outcomes are used less frequently than clinical outcomes in day-to-day routine care.

Prevalence and related factors of poor sleep quality in patients with pre-dialysis chronic kidney disease

BACKGROUND

Sleep disturbances in patients with chronic kidney disease (CKD) are related to decreased quality of life and increased health-related risks. There is insufficient data about actual prevalence and related factors of poor sleepers in this group. In this study, we aimed to investigate prevalence and related risk factors of self-reported poor sleep quality in patients with pre-dialysis CKD.

METHODS

In this cross-sectional study, 259 pre-dialysis CKD patients (median age 56 years; range, 19-85) were included. Demographical, clinical and laboratory correlates were recorded. Body mass index (BMI) was calculated. Estimated glomerular filtration rate (eGFR) was calculated by the Modification of Diet in Renal Disease (MDRD) formula. Sleep quality was assessed by Pittsburgh Sleep Quality Index (PSQI), a self-rated questionnaire. Depression was evaluated using the Beck Depression Inventory (BDI).

RESULTS

Median eGFR was 27.6 ml/min/1.73 m² (range, 9-56). Of the 259 patients, 110 (42.5%) were poor sleepers with global PSQI score >5. The univariate correlation analysis revealed that global PSQI score was positively correlated with age, BMI, waist circumferences (WC), hip circumferences (HC), serum phosphorus and triglyceride levels, systolic blood pressure (BP), pulse pressure and BDI score, and negatively correlated with male gender and hemoglobin level. Logistic regression analysis, showed that HC, systolic BP, and BDI scores were independently associated with poor sleep quality (p = 0.001, p = 0.020 and p < 0.001, respectively).

CONCLUSION

Prevalence of poor sleep quality in our pre-dialysis CKD patients was 42.5%. Systolic BP, depression and HC, all of these are potentially correctable factors, were associated with poor sleep quality independently.

Associations Between Self-Reported Sleep Disturbances and Cognitive Impairment: A Population-Based Cross-Sectional Study

OBJECTIVE

Cognitive impairment is a rapidly growing global public health problem in China and worldwide. In the recent decades, emerging studies have explored the associations between sleep disturbances and cognitive impairment. However, the variety of the results imply us that further studies should be conducted for the associations.

METHODS

This is a cross-sectional study conducted between August and October 2018 in five cities in Hebei province, China. Subjects were 21,376 community residents. Cognitive impairment was screened by the Chinese version of the Mini-Mental State Examination (MMSE). Scales of Athens Insomnia Scale (AIS), Berlin Questionnaire (BQ), REM (rapid eye movement) Sleep Behavior Disorder Questionnaire (RBDQ-HK), Ullanlinna Narcolepsy Scale (CUNS), and Cambridge-Hopkins Restless Legs Syndrome Questionnaire (CH-RLSq) were used to access insomnia, sleep apnea, REM sleep behavior disorder, narcolepsy, and restless leg syndrome.

RESULTS

The mean ± SD (standard error) of MMSE, AIS, RBDQ-HK, and CUNS were 27.95 ± 4.79, 2.16 ± 3.39, 5.55 ± 7.75, and 3.76 ± 2.31, respectively. Among the participants, 10.6% and 1.5% of the participants were identified as having a high risk of sleep apnea and restless leg syndrome, respectively. The results of multiple linear regression showed that cognitive impairment was associated with insomnia (β = -0.037, p < 0.001) and narcolepsy (β = -0.023, p < 0.001). The association between sleep apnea (β = -0.002, p > 0.05), REM sleep behavior disorder (β = 0.006, p > 0.05), restless leg syndrome (β = -0.007, p > 0.05), and cognitive impairment were not supported. Other factors associated with cognitive impairment were gender, age, education level, married status, and region.

CONCLUSION

This study provides some epidemiological evidence for the association between sleep disturbances and cognitive impairment among community residents in central China. In this study, the associations between insomnia, narcolepsy, and cognitive impairment were identified, but the associations between sleep apnea, REM sleep behavior disorder, narcolepsy, restless leg syndrome, and cognitive impairment were not supported among community residents.

Correlates of objective sleep quality in older peritoneal dialysis patients

BACKGROUND

Sleep disturbance is a prominent concern in dialysis patients and detrimentally impacts clinical and self-reported health outcomes. This study aimed to collect sleep data from in-home actigraphy and to explore possible predictors of sleep quality in older peritoneal dialysis patients.

METHODS

This was a cross-sectional study. Peritoneal dialysis patients aged ≥60 years participated in this study. For each participant, sleep quality was assessed by analyzing the data produced by an actigraphic device worn on the wrist 24 h a day for seven consecutive days. Physical function was assessed using handgrip strength and the Timed Up and Go test. Depression was assessed using the self-reported Geriatric Depression Scale. Multiple linear regression analyses were performed to examine the factors influencing sleep efficiency and sleep time.

RESULTS

Based on data collected from 50 participants (N = 50, mean age 70.4 years, 70% male), including 333 nights of actigraphy-monitored sleep, the mean sleep efficiency was 75.5%±14.2% and the mean total sleep time 391.0 ± 99.3 min per night. Higher hemoglobin (β = 0.38, p = 0.007) and lower serum phosphorus (β = -0.30, p = 0.042) levels were significant predictors of better sleep efficiency. The only significant predictor of the total sleep time was age (β = 0.32, p = 0.021).

CONCLUSION

Older peritoneal dialysis patients had poor sleep, characterized by low sleep efficiency. Low hemoglobin and high serum phosphorus levels were predictors of poor sleep efficiency and, as such, modifiable factors for clinicians to consider when treating patients with sleep complaints.

Dietary nutrients' intake and sleep quality in peritoneal dialysis patients

Sleep disturbances are common in dialysis patients. However, there is a lack of information on nutritional determinants of sleep disorders in dialysis patients. The objective of the current study was to investigate the association between nutrients’ intake and sleep quality in peritoneal dialysis patients. The cross-sectional study was done on 114 peritoneal dialysis patients referred to Alzahra and Khorshid hospitals, Isfahan, Iran. Information on sleep quality and dietary intakes were collected using Pittsburgh sleep quality index and 168-item food frequency questionnaire respectively. Anthropometric measurements were done by a trained dietitian based on standard protocols. Socio-demographic and clinical data were obtained through a structured questionnaire. The binary logistic regression model was used to detect the association between nutrients’ intake and sleep quality. Our results indicated that there was not any significant difference in basic (socio-demographic and clinical) characteristics between peritoneal dialysis patients with good and poor sleep quality (p>0.05). The results of logistic regression indicated a positive significant association between dietary intake of carbohydrate (OR:3;95% CI:1.32-6.81; p<0.05), fat (OR:3;95% CI:1.32-6.81; p<0.05), and fiber (OR:2.53;95% CI: 1.12-5.67; p<0.05) with poor sleep quality in crude and adjusted models (p<0.05). However, there was not any significant association between dietary intake of protein and poor sleep quality (p>0.05). The results of the present study indicated that dietary intake of nutrients affect sleep quality in dialysis patients. These results help healthcare professionals in making nutritional interventions to improve sleep quality in dialysis patients.

Risk factors for sleep disorders in patients undergoing peritoneal dialysis

Sleep disorders in patients with end-stage renal disease are common but have rarely been reported in previous studies. Therefore, we examined the prevalence of sleep disorders and the risk factors for declining sleep quality in patients undergoing peritoneal dialysis (PD). A multicenter prospective cohort study was conducted at five PD centers across different provinces in China. A total of 449 patients who underwent PD between March to November 2013 were enrolled. Demographic data, laboratory indicators, presence of depression, and sleep assessment data were collected. Sleep questionnaires reflecting five categories of sleep disorders, namely, insomnia, restless legs syndrome, excessive daytime sleepiness, possible narcolepsy, and sleepwalking and nightmares, were administered at baseline and at 24 months postoperatively. Sleep disorders were diagnosed when a patient had at least one sleep problem. At baseline, 335 (74.6%) patients had at least one type of sleep disorder. Depression, diabetes mellitus (DM), and male were found to be associated with the presence of a sleep disorder. At follow-up, the prevalence of insomnia, restless legs syndrome, and excessive daytime sleepiness had significantly increased in 285 patients. Furthermore, cardiovascular disease (CVD) was found to be associated with the presence of sleep disorders in patients with one or more disorders at baseline, whereas a low serum albumin level was found to be associated with sleep disorders in patients without any sleep disorders at baseline. The prevalence of sleep disorders was relatively high among PD patients at baseline and increased afterthe2-year follow-up. Depression, DM, and male were associated with all sleep disorders at baseline. CVD was associated with the presence of a sleep disorder at baseline and worse sleep quality at the 2-year follow-up; whereas a low serum albumin level was associated with the risk of acquiring a sleep disorder at the 2-year follow-up among patients with normal sleep status at baseline.

A holistic approach to factors affecting depression in haemodialysis patients

Depression in dialysis populations is affected by co-morbid diseases, such as cardiovascular disease, diabetes, and immune dysfunction, and it also includes high suicide risk and frequent hospitalizations. Depressive disorders have a close association with malnutrition and chronic inflammation, as well as with cognitive impairment. Impaired cognitive function may be manifested as low adherence to dialysis treatment, leading to malnutrition. Additionally, chronic pain and low quality of sleep lead to high rates of depressive symptoms in haemodialysis patients, while an untreated depression can cause sleep disturbances and increased mortality risk. Depression can also lead to sexual dysfunction and non-adherence, while unemployment can cause depressive disorders, due to patients' feelings of being a financial burden on their family. The present review provides a holistic approach to the factors affecting depression in haemodialysis, offering significant knowledge to renal professionals.

Effect of Sedative-Hypnotic Medicines on Mortality in Peritoneal Dialysis Patients with Sleep Disorders: A Retrospective Cohort Study

BACKGROUND

Sedative-hypnotic medication is widely used among continuous ambulatory peritoneal dialysis (CAPD) patients with sleep disorders; however, its effect on mortality has rarely been investigated.

METHODS

Logistic regression was employed to identify factors associated with sedative-hypnotic medication, whose effect on mortality was evaluated by Cox proportional hazards models.

RESULTS

A total of 146 CAPD patients with sleep disorders were recruited, of which 46 patients (31.5%) used either benzodiazepines or zolpidem. Sedative-hypnotic medication was more frequently used by older patients and those with longer duration of CAPD therapy and there was no significant association between sedative-hypnotic medicines and all-cause mortality after adjusting for age, gender, diabetes, cardiovascular disease, and duration of CAPD.

CONCLUSION

Sedative-hypnotic medication was more often used by older patients and patients with a longer duration of CAPD. There was no association between these agents and all-cause mortality in CAPD patients with sleep disorders.

Sleep quality and risk factors of atherosclerosis in predialysis chronic kidney disease

INTRODUCTION

Chronic kidney disease (CKD) patients have more frequent sleep disorders and cardiovascular disease than normals. Since arterial stiffness as a risk factor of atherosclerosis can be evaluated with pulse wave velocity (PWV), we aimed to investigate the prevalance of sleep quality (SQ) and the relationship between SQ and risk factors of atherosclerosis and whether there is a relationship between SQ and PWV (the indicator of arterial stiffness) in predialysis CKD patients.

METHODS

This cross-sectional study was carried out in CKD patients followed at the Nephrology Department in Konya, Turkey, between November 2014 and March 2015. A total of 484 CKD patients were screened. Of the 484 patients, 285 patients were excluded. The remaining 199 CKD patients without cardiovascular disease at stage 3, 4, and 5 (predialysis) were included in the final study. The SQ of the patients was evaluated by the Pittsburgh Sleep Quality Index (PSQI). PWV was measured by using a single-cuff arteriography device (Mobil-O-Graph PWA, a model pulse wave analysis device; IEM).

RESULTS

A total of 199 predialysis CKD patients were included in the study, 73 of whom (36.7 %) were 'poor sleepers' (global PSQI &gt;5). Patients with poor SQ were older than those with good SQ (p = 0.077). SQ was worse in female patients compered to male patients (p = 0.001). SQ was worse in obese patients. As laboratory parameters, serum phosphorus, LDL cholesterol, and triglycerides levels correlated positively with SQ (respectively; r = 0.245, p&amp;0.001; r = 0.142, p = 0.049; r = 0.142, p = 0.048). The indicator of arterial stiffness, PWV, was higher in patients with poor SQ (p = 0.033). Hyperphosphatemia and female gender are determined as risk factors for poor SQ in multivariate analysis (p = 0.049, ExpB = 1.477; p = 0.009, ExpB = 0,429, respectively).

CONCLUSIONS

Our study showed for the first time that there is a relationship between SQ and risk factors of atherosclerosis in predialysis CKD patients.

Sleep Among Long-Term Care Residents in China: A Narrative Review of Literature

The objective of this study is to synthesize and evaluate the current body of sleep research among long-term care (LTC) residents in China and provide insights for future research. Systematic searches identified 15 studies that examined sleep in LTC residents in China. Sleep disturbances and poor sleep quality were prevalent in Chinese LTC residents. Eight cross-sectional studies reported that demographics, comorbidities, lifestyle, and environment were associated with sleep quality in Chinese LTC residents. Seven intervention studies, including exercise, traditional Chinese medicine, light therapy, and behavioral interventions resulted in improved sleep quality. Only subjective sleep measures were used in all 15 studies. Some methodological issues were identified in studies, especially those conducted in Mainland China. Sleep research in LTC residents in China is still at the beginning stages. Future studies should consider more rigorous designs and objective sleep measures, and develop target interventions based on factors associated with sleep disturbances.

Sleep Disturbance, Sleep Duration, and Inflammation: A Systematic Review and Meta-Analysis of Cohort Studies and Experimental Sleep Deprivation

BACKGROUND

Sleep disturbance is associated with inflammatory disease risk and all-cause mortality. Here, we assess global evidence linking sleep disturbance, sleep duration, and inflammation in adult humans.

METHODS

A systematic search of English language publications was performed, with inclusion of primary research articles that characterized sleep disturbance and/or sleep duration or performed experimental sleep deprivation and assessed inflammation by levels of circulating markers. Effect sizes (ES) and 95% confidence intervals (CI) were extracted and pooled using a random effect model.

RESULTS

A total of 72 studies (n > 50,000) were analyzed with assessment of C-reactive protein (CRP), interleukin-6 (IL-6), and tumor necrosis factor α (TNFα). Sleep disturbance was associated with higher levels of CRP (ES .12; 95% CI = .05-.19) and IL-6 (ES .20; 95% CI = .08-.31). Shorter sleep duration, but not the extreme of short sleep, was associated with higher levels of CRP (ES .09; 95% CI = .01-.17) but not IL-6 (ES .03; 95% CI: -.09 to .14). The extreme of long sleep duration was associated with higher levels of CRP (ES .17; 95% CI = .01-.34) and IL-6 (ES .11; 95% CI = .02-20). Neither sleep disturbances nor sleep duration was associated with TNFα. Neither experimental sleep deprivation nor sleep restriction was associated with CRP, IL-6, or TNFα. Some heterogeneity among studies was found, but there was no evidence of publication bias.

CONCLUSIONS

Sleep disturbance and long sleep duration, but not short sleep duration, are associated with increases in markers of systemic inflammation.

Objective and subjective sleep disorders in automated peritoneal dialysis

Background

Automated peritoneal dialysis (APD) is one of the fastest growing dialysis modalities. It is unknown whether sleep and mood are disturbed while performing repeated overnight exchanges.

Objectives

In this report, we aim to describe and compare the prevalence of sleep-disordered breathing (SDB), periodic limb movements (PLMS), poor sleep quality (SQ), and depression among APD patients compared with stages 3b–5 (estimated glomerular filtration rate ≤44 ml/min/1.73 m2) chronic kidney disease (CKD) and hemodialysis (HD) patients.

Design

This is a cross-sectional, descriptive study.

Setting

Study participants were recruited from outpatient nephrology clinics, local dialysis centers, and the Thomas E. Starzl Transplant Institute in Western Pennsylvania between April 2004 and July 2009.

Patients

There were 186 participants in this study including 22 APD patients, 89 CKD patients, and 75 HD patients.

Measurements

In-home polysomnography was performed and two questionnaires were completed, the Pittsburgh Sleep Quality Index (PSQI) and the Patient Health Questionnaire-9 (PHQ-9).

Methods

SDB and PLMS were quantified by in-home unattended polysomnography; poor SQ was defined by a score >5 on the PSQI, and the presence of moderate to severe depression was defined by a score >5 on the PHQ-9.

Results

The APD patients had a median age of 37.5 years, were predominantly female (72.7 %), and had a median body mass index (BMI) of 23.8 kg/m2. In univariate analyses, APD patients had significantly lower apnea-hypopnea index compared to HD patients by 12.2 points (likelihood ratio test p = 0.008) and revealed the least percent of TST with nocturnal hypoxemia compared to CKD patients by 2.7 points, respectively (likelihood ratio test p = 0.01). The APD group had also significantly greater stages 3 to 4 sleep compared to the CKD patients by 8.6 points (likelihood ratio test p = 0.009). In multivariate analyses and after adjustment for age, gender, race, and BMI, both APD and HD patients had higher average PSQI scores than CKD patients by 2.54 and 2.22 points, respectively (likelihood ratio test p = 0.005). No other comparisons of sleep parameters among groups reached statistical significance.

Limitations

The limitations of this study are the small sample size of the APD population and the demographic and clinical differences among the three study groups.

Conclusions

Despite differences in univariate analyses, after multivariate adjustment, APD patients had similar sleep parameters and sleep architecture and as poor SQ and symptoms of depression as HD patients. Future studies with larger APD cohorts are needed.

A review of the neuro- and systemic inflammatory responses in post concussion symptoms: Introduction of the "post-inflammatory brain syndrome" PIBS

Post-concussion syndrome is an aggregate of symptoms that commonly present together after head injury. These symptoms, depending on definition, include headaches, dizziness, neuropsychiatric symptoms, and cognitive impairment. However, these symptoms are common, occurring frequently in non-head injured controls, leading some to question the existence of post-concussion syndrome as a unique syndrome. Therefore, some have attempted to explain post-concussion symptoms as post-traumatic stress disorder, as they share many similar symptoms and post-traumatic stress disorder does not require head injury. This explanation falls short as patients with post-concussion syndrome do not necessarily experience many key symptoms of post-traumatic stress disorder. Therefore, other explanations must be sought to explain the prevalence of post-concussion like symptoms in non-head injury patients. Many of the situations in which post-concussion syndrome like symptoms may be experienced such as infection and post-surgery are associated with systemic inflammatory responses, and even neuroinflammation. Post-concussion syndrome itself has a significant neuroinflammatory component. In this review we examine the evidence of neuroinflammation in post-concussion syndrome and the potential role systemic inflammation plays in post-concussion syndrome like symptoms. We conclude that given the overlap between these conditions and the role of inflammation in their etiologies, a new term, post-inflammatory brain syndromes (PIBS), is necessary to describe the common outcomes of many different inflammatory insults. The concept of post-concussion syndrome is in its evolution therefore, the new term post-inflammatory brain syndromes provides a better understanding of etiology of its wide-array of symptoms and the wide array of conditions they can be seen in.

Executive summary of the KDIGO Controversies Conference on Supportive Care in Chronic Kidney Disease: developing a roadmap to improving quality care

Patients with advanced chronic kidney disease (CKD) have a high burden of physical and psychosocial symptoms, poor outcomes, and high costs of care. Current paradigms of care for this highly vulnerable population are variable, prognostic and assessment tools are limited, and quality of care, particularly regarding conservative and palliative care, is suboptimal. The KDIGO Controversies Conference on Supportive Care in CKD reviewed the current state of knowledge in order to define a roadmap to guide clinical and research activities focused on improving the outcomes of people living with advanced CKD, including those on dialysis. An international group of multidisciplinary experts in CKD, palliative care, methodology, economics, and education identified the key issues related to palliative care in this population. The conference led to a working plan to address outstanding issues in this arena, and this executive summary serves as an output to guide future work, including the development of globally applicable guidelines.

Management of a rapidly growing peritoneal dialysis population at the First Affiliated Hospital of Sun Yat-sen University

Managing a rapidly growing peritoneal dialysis program with more than 1000 patients involves multiple challenges, labor constraints, logistics, and excessive geographic distance. This paper describes how Sun Yat-sen University, Guangzhou, China, manages those issues, while simultaneously improving quality of the care and, subsequently, clinical outcomes.

Sleep quality and its correlates in patients with chronic kidney disease: a cross-sectional design

PURPOSE

Since sympathovagal imbalance influences clinical phenomena, such as hypertension, diabetes mellitus, chronic kidney disease (CKD) and sleeping problems, there should be correlations between these conditions. We hypothesized that sleep quality would be correlated with estimated glomerular filtration rate (eGFR), blood pressure and the presence of diabetes.

METHODS

We included 303 CKD patients in this study. We employed the Pittsburgh Sleep Quality Index (PSQI), Beck Depression Inventory (BDI) and Short Form 36 Quality of Life Health Survey Questions (SF-36) to screen sleeping disturbances, depression and quality of life, respectively. A chart review was performed for the patients' demographics, diagnoses and certain laboratory parameters--including blood glucose, hemoglobin, albumin, calcium, phosphate, parathyroid hormone and eGFR. Multivariate logistic regression models were employed to estimate odds ratios with 95% confidence intervals.

RESULTS

We included 303 patients in this cross-sectional study. A total of 101 patients were on dialysis. In the univariate models, gender, calcium and mental component summary scores (MCS) reached a significant level of 0.1, and those covariates were included in the multivariate analysis. The reduced models included gender and MCS categories. Female gender increases the risk for poor sleep quality. In our report, evidence suggests MCS domain scores are inversely related to the risk for impaired sleep.

CONCLUSION

Our results indicated a high burden of sleep disturbances in kidney patients. In addition, female gender and having low MCS scores may influence sleep quality in kidney patients.

Prevalence and Associated Factors of Uraemic Pruritus in Continuous Ambulatory Peritoneal Dialysis Patients

OBJECTIVE

Uraemic pruritus is a distressing symptom that has a negative impact on the quality of life for dialysis patients. The pathophysiology of pruritus in peritoneal dialysis (PD) patients is still poorly understood. The present study aims to investigate the prevalence and related risk factors of pruritus in continuous ambulatory peritoneal dialysis (CAPD) patients.

METHODS

In total, 362 CAPD cases were investigated from January 2012 to April 2013. Pruritus was assessed by visual analogue scale.

RESULTS

The prevalence of severe pruritus and mild to moderate pruritus was 12.7% and 52.5%, respectively. The patients with severe pruritus had the longest duration of PD (p<0.001), Pittsburgh Sleep Quality Index (PSQI) score (p<0.001), Beck Depression Inventory (BDI) score (p=0.003), intact parathyroid hormone (iPTH) level (p=0.009), and the lowest Medical Outcomes Short Form 36 Health Survey, Physical Component Score (SF-36 PCS) (p<0.001) among the three groups. The patients with mild to moderate pruritus had a significantly higher iPTH level (p=0.004) compared with the patients without pruritus. A multivariate logistic regression for pruritus showed that higher PSQI score [odds ratio (OR)=1.305, p=0.001], higher BDI score (OR=1.429, p=0.002), longer vintage (OR=1.039, p=0.004), and higher iPTH level (OR=1.317, p=0.014) were independently associated with pruritus.

CONCLUSION

The prevalence of uraemic pruritus was 65.2% in CAPD patients. Sleep disorder, depression, longer vintage, and a higher iPTH level were independent associated factors for pruritus in CAPD patients.

Cancer patients under maintenance hemodialysis: relationship between quality of life, depression, sleep quality and malnutrition-inflammation score

BACKGROUND

The kidney is one major organ affected by cancer and its associated therapies. The aim of this study was to compare the levels of depression, quality of life and sleep quality in hemodialysis patients with or without cancer, and to analyze the associations with the malnutrition-inflammation score (MIS).

PATIENTS AND METHODS

In this cross-sectional study, 40 cancer patients under hemodialysis and 44 patients under hemodialysis without cancer who served as the control group were included. Participants underwent structured interviews to investigate depression, quality of life, sleep quality and restless legs syndrome.

RESULTS

Hemodialysis patients with cancer had a greater depression score (16.5 ± 4.8 vs. 10.8 ± 5.2, p < 0.001). Patients had similar physical and mental composite quality of life scores. Patients under hemodialysis with cancer had poor quality of sleep (mean score 8.8 ± 3.5 vs. 6.4 ± 4.1, p = 0.011) and a higher prevalence of restless leg syndrome (55.9 vs. 25.7%, p = 0.011). These features were associated with MIS in patients without cancer but not in patients with cancer.

CONCLUSION

Cancer patients undergoing hemodialysis present a higher prevalence of depression, poor quality of life, sleep disorders; however, associations of these features with MIS are different in hemodialysis patients with or without cancer. These findings can change the clinical approach to these patients.

Association between sleep quality and cardiovascular damage in pre-dialysis patients with chronic kidney disease

Background

Poor sleep quality, a novel risk factor of cardiovascular diseases (CVD), is highly prevalent in patients with chronic kidney disease (CKD). The association between poor sleep quality and cardiovascular damage in patients with CKD is unclear. This study is aimed to assess the prevalence and related risk factors of sleep disturbance and determine the relationship between sleep quality and cardiovascular damage in Chinese patients with pre-dialysis CKD.

Methods

A total of 427 pre-dialysis CKD patients (mean age = 39 ± 15 years, 260 male/167 female) were recruited in this study. The demographics and clinical correlates were collected. The sleep quality was measured by the Pittsburgh Sleep Quality Index (PSQI), whereas the cardiovascular damage indicators (the Early/late diastolic peak flow velocity (E/A) ratio and left ventricular mass index (LVMI)) were determined by an echocardiographic examination.

Results

Of the CKD patients, 77.8% were poor sleepers as defined by a PSQI score > 5. Median estimated glomerular filtration rate (eGFR) was 69.4(15.8-110.9) ml/min/1.73 m². Logistic regression analysis revealed that left ventricular hypertrophy (LVH) was independently associated with the PSQI score (OR = 1.092, 95% CI = 1.011-1.179, p = 0.025), after adjustment for age, sex and clinical systolic blood pressure, diastolic blood pressure, Phosphate, Intact parathyroid hormone (iPTH), Hemoglobin and eGFR. The linear regression analysis showed that the E/A ratios were independently associated with the PSQI score (β = -0.115, P = 0.028) after adjustment for a series of potential confounding factors.

Conclusions

Poor sleep quality, which is commonly found in pre-dialysis CKD patients, is an independent factor associated with cardiovascular damage in CKD patients. Our finding implies that the association between poor sleep and CVD might be mediated by cardiac remodeling.

Health-related qualıty of lıfe, sleep qualıty, and depressıon in peritoneal dialysis and hemodıalysıs patıents

Health-related quality of life (HRQoL) and sleep quality (SQ) were impaired in patients with end-stage renal disease (ESRD). The impairment of both HRQoL and SQ and being in a depressive mood were found to be associated with increased morbidity and mortality in dialysis patients. We aimed to investigate the association between SQ, HRQoL, and depression, and to define independent predictors of SQ and depression in peritoneal dialysis (PD) and hemodialysis (HD) patients. Ninety HD patients (41 females, 49 males with mean age 50 ± 15.7 years) and 64 PD patients (27 females, 37 males with mean age 52.4 ± 15.3 years) receiving renal replacement therapy for at least 3 months were screened for the assessment of SQ, HRQoL, and depression in this cross-sectional study. A modified postsleep inventory, Short Form of Medical Outcomes Study (SF-36) and Beck depression inventory (BDI) were applied to all patients for evaluating SQ, HRQoL, and depression, respectively. HD and PD patients had similar total SQ scores. Physical and mental component scale of HRQoL were found to be significantly higher in HD patients (p < 0.001). PD patients were found to be much more in depressive mood when compared with HD patients (p < 0.001). Independent predictors of depression in patients were mental component scale of HRQoL, gender (being female), and dialysis modality (being PD patient). Physical component scale was also found to be an independent predictor of SQ. This study showed that despite similar SQ scores between two groups, HD patients had better HRQoL and less depression than PD patients.

The effect of social support and coping style on depression in patients with continuous ambulatory peritoneal dialysis in southern China

PURPOSE

To explore the effect of social support and coping style on depression in patients on CAPD in Southern China.

METHODS

The patients undergoing CAPD therapy for more than 3 months were recruited from Jan 1 to May 31, 2009. The Beck Depression Inventory-II (BDI-II), Social Support Rating Scale, Medical Coping Modes Questionnaire, and Medical Outcomes Study Short Form (SF-36) were used to evaluate depression, social support, coping style, and quality of life (QoL), respectively.

RESULTS

Of the 191 recruited patients, 65 patients (34.0 %) suffered from depression, with a BDI-II score of 23.8 ± 8.4. The average score of QoL (44.9 ± 13.9 vs. 64.7 ± 14.2, p < 0.001), social support (37.9 ± 7.2 vs. 42.1 ± 7.3, p < 0.001), and "confrontation" coping style (17.2 ± 3.9 vs. 18.8 ± 3.8, p = 0.006) in depressed patients was significantly lower than those in non-depressed patients, respectively. While the depressed patients had significantly higher score of "acceptance-resignation" coping style (12.9 ± 2.5 vs. 10.4 ± 3.5, p < 0.001) compared with those of non-depressed patients. Univariate analysis showed that the BDI-II score was negatively associated with social support (r = -0.284, p < 0.001) and "confrontation" (r = -0.180, p = 0.013), but positively associated with "acceptance-resignation" (r = 0.482, p < 0.001). Logistic regression analysis revealed that age (OR = 0.971, p = 0.038), female sex (OR = 2.211, p = 0.039), diabetes mellitus (OR = 3.046, p = 0.015), long PD duration (OR = 1.021, p = 0.020), fatigue (OR = 2.500, p = 0.032), high Pittsburgh Sleep Quality Index (PSQI) score (OR = 1.143, p = 0.001), low social support (OR = 0.945, p = 0.046), and high "acceptance-resignation" (OR = 1.096, p = 0.020) were independently associated with depression.

CONCLUSION

There was a high prevalence of depression in CAPD patients. Age, female sex, diabetes mellitus, long PD duration, fatigue, sleep disturbance, low social support, and high "acceptance-resignation" coping style were independently associated with depression.

Sleep quality, depression, and quality of life in elderly hemodialysis patients

OBJECTIVE

Both the incidence and the prevalence of end-stage renal disease (ESRD) in elderly patients are increasing worldwide. Elderly ESRD patients have been found to be more prone to depression than the general population. There are many studies that have addressed the relationship between sleep quality (SQ), depression, and health related quality of life (HRQoL) in ESRD patients, but previous studies have not confirmed the association in elderly hemodialysis (HD) patients. Therefore, the aim of the present study was to demonstrate this relationship in elderly HD patients.

PATIENTS AND METHODS

Sixty-three elderly HD patients (32 females and 31 males aged between 65 and 89 years) were included in this cross-sectional study. A modified Post-Sleep Inventory (PSI), the Medical Outcomes Study 36-item short form health survey, and the Beck Depression Inventory (BDI) were applied.

RESULTS

The prevalence of poor sleepers (those with a PSI total sleep score [PSI-4 score] of 4 or higher) was 71% (45/63), and the prevalence of depression was 25% (16/63). Of the 45 poor sleepers, 15 had depression, defined as a BDI score of 17 or higher. Poor sleepers had a significantly higher rate of diabetes mellitus (P = 0.03), significantly higher total BDI scores, and lower Physical Component Scale scores (ie, lower HRQoL) than good sleepers. The PSI-4 score correlated negatively with Physical Component Scale (r = -0.500, P < 0.001) and Mental Component Scale scores (r = -0.527, P < 0.001) and it correlated positively with the BDI score (r = 0.606, P < 0.001). In multivariate analysis, independent variables of PSI-4 score were BDI score (beta value [β] = 0.350, P < 0.001), Mental Component Scale score (β = -0.291, P < 0.001), and age (β = 0.114, P = 0.035).

CONCLUSION

Poor SQ is a very common issue and is associated with both depression and lower HRQoL in elderly HD patients.