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Abstract: TH-PO326

Association of Self-Reported Sleep Quality with Frailty in Patients on Hemodialysis

Session Information

Category: Dialysis

  • 701 Dialysis: Hemodialysis and Frequent Dialysis


  • Wulczyn, Kendra E., University of California San Francisco, San Francisco, California, United States
  • Grimes, Barbara A., UCSF, San Francisco, California, United States
  • Johansen, Kirsten L., University of California, San Franicsco, San Francisco, California, United States

Poor sleep quality is associated with frailty in the elderly, yet the relationship has not been examined in patients on hemodialysis, among whom the prevalence of both poor sleep quality and frailty is higher. We examine the association of sleep quality with frailty in patients on hemodialysis over a two-year period.


We used ordinal generalized estimating equation analysis to examine the association between self-reported sleep quality and frailty and change in frailty over time in a cohort of 762 hemodialysis patients. Frailty was measured using the Fried frailty phenotype and modeled according to the number of components met. Participants rated sleep quality on a Likert scale in 3 domains: sleep initiation, sleep maintenance, and returning to sleep. A score of 16 or greater on the Center for Epidemiologic Studies-Depression scale indicated depressive symptoms. Measures were conducted at baseline, 12, and 24 mos.


Self-reported difficulty with sleep initiation, sleep maintenance, and trouble returning to sleep were associated with significantly higher odds of being frail in multivariate analysis (table). Impaired sleep maintenance and trouble returning to sleep were also associated with worsening frailty over time. Addition of the inflammatory marker IL-6 did not weaken the association between sleep quality and frailty. The addition of depression to the multivariate model markedly attenuated the association between sleep quality and frailty in all three sleep domains.


Poor sleep quality was associated with higher odds of frailty in patients on hemodialysis, and impaired sleep maintenance and trouble returning to sleep were associated with worsening frailty over time. Our analyses suggest that inflammation does not solely account for these findings and that depression may play a large role in the causal pathway between sleep and frailty.

Odds ratio of higher frailty score and change in frailty over time
VariableMultivariate‡Addition of IL-6Addition of Depression
FrailtyChange in FrailtyFrailtyChange in FrailtyFrailtyChange in Frailty
Sleep initiation1.6* (1.2 - 2.1)1.2 (0.9 - 1.6)1.5* (1.2 - 2.0)1.1 (0.9 - 1.5)1.1 (0.9 - 1.5)0.9 (0.7 - 1.2)
Sleep maintenance1.6* (1.2 - 2.1)1.5* (1.2 - 1.9)1.5* (1.2 - 2.0)1.5* (1.2 - 1.9)1.2 (1.0 - 1.6)1.3* (1.0 - 1.6)
Trouble returning to sleep1.7* (1.3 - 2.2)1.3* (1.0 - 1.7)1.7* (1.3 - 2.2)1.3 (1.0 - 1.6)1.3 (1.0 - 1.7)1.1 (0.8 - 1.4)
IL-6, pg/mL----1.4* (1.2 - 1.5)--1.4* (1.2 - 1.5)--
Depression--------2.7* (2.2 - 3.3)--

*p<0.05 ‡Adjusted for age, race, ethnicity, sex, BMI, serum albumin, smoking, diabetes, atherosclerotic heart disease, heart failure


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