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Abstract: TH-PO325

Interventions to Improve Sleep Quality in People with CKD: A Cochrane Systematic Review

Session Information

Category: Dialysis

  • 701 Dialysis: Hemodialysis and Frequent Dialysis


  • Natale, Patrizia, Diaverum, Bari, Italy
  • Palmer, Suetonia, University of Otago, Christchurch, New Zealand
  • Ruospo, Marinella, Diaverum, Bari, Italy
  • Saglimbene, Valeria Maria, Diaverum, Bari, Italy
  • Hegbrant, Jorgen BA, Diaverum Renal Services Group, Lund, Sweden
  • Strippoli, Giovanni F.M., Diaverum, Bari, Italy

Sleep quality is lower for people with chronic kidney disease (CKD). The prevalence of sleep disorder ranges from 45% to 80% in adults with end-stage kidney disease (ESKD) and half of patients with earlier stages of CKD. People with CKD have identified the importance of research focused on better treatments to reduce symptoms of CKD. This Cochrane review evaluates the benefits and harms of interventions to improve sleep quality for adults and children with CKD.


We searched the Cochrane Kidney Transplant Specialised Register for randomized trials reporting treatment on sleep quality for people with CKD through April 2018. Two authors independently screened citations for eligibility, extracted data, and assessed risk of bias using the Cochrane tool. Evidence certainty was adjudicated using GRADE. Sleep quality was measured by validated sleep scores.


Sixty-seven studies (3427 participants) met review eligibility criteria. Sixty-one studies (3201 participants) involved dialysis patients, three studies involved 104 transplant recipients, and one study involved 45 patients with CKD. Median trial duration was 5 weeks. Mean trial age was 54.3 years. Interventions included acupressure, aromatherapy, benzodiazepine therapy, cognitive-behavioral therapy, dopaminergic agonists, education, exercise, light therapy, massage, melatonin, music therapy, peritoneal dialysis technique, reflexology, relaxation, and telephone support. Methodological reporting was incomplete for most studies. Relaxation had uncertain effects on sleep quality (mean difference [MD] -1.62, 95% confidence interval [CI] -5.03, 1.79; very low certainty evidence). Exercise may provide improvements in sleep quality (standardized MD -1.10, -2.26, 0.05; very low certainty). Acupressure compared to no treatment may improve sleep quality (MD -1.27, -2.13, -0.40; very low certainty) and sleep latency (MD -0.59, -0.92, -0.27; moderate certainty), although effects were smaller than clinically important changes in sleep scores. Effects of other interventions on sleep quality were very uncertain. Evidence in children was absent.


Exercise and acupressure may provide small clinical improvements in sleep quality for people with CKD, although limitations in existing trials reduce the certainty of these findings.