Abstract: FR-PO1031
Psychosocial Factors Outperform Traditional Biological Markers as Independent Correlates of Poor Sleep Quality in Patients on Hemodialysis: A Multicenter Cross-Sectional Analysis
Session Information
- Hemodialysis: Clinical Challenges, Patient-Centered Outcomes, and Quality of Life
October 23, 2026 | Location: Exhibit Hall A, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Dialysis
- 801 Dialysis: Hemodialysis and Frequent Dialysis
Authors
- Gemene, Emanuela Marta, Diaverum Romania, Bucharest, Romania
- Tacu, Catalin, Diaverum Romania, Bucharest, Romania
- Pislaru, Corina, Diaverum Romania, Bucharest, Romania
- Fociuc, Maria Gabriela, Diaverum Romania, Bucharest, Romania
- Moro, Daniela Carmen, Diaverum Romania, Bucharest, Romania
Background
Sleep disturbance is highly prevalent in patients receiving maintenance hemodialysis and is associated with adverse clinical outcomes, yet its determinants remain incompletely understood. We aimed to jointly evaluate biological and psychosocial factors to identify independent correlates of poor sleep quality in a multicenter HD cohort.
Methods
We conducted a multicenter cross-sectional study of 431 adult HD patients across three hemodialysis centers in Romania. Poor sleep quality was defined as a self-reported global rating of “fairly bad” or “very bad” sleep in the preceding month. Candidate predictors included demographic and clinical variables, eight laboratory parameters (hemoglobin, albumin, ferritin, transferrin saturation, calcium, phosphorus, iPTH, spKt/V), and five psychosocial/sleep-related factors (perceived stress, physical pain, pre-dialysis night disruption, sleep medication use, daytime somnolence). Multivariable logistic regression was performed on complete cases (N=428). Model performance was assessed using AUC-ROC and calibration by the Hosmer–Lemeshow test.
Results
AAmong 431 HD patients, 124 (28.8%) reported poor sleep quality. In multivariable analysis, all independent predictors were psychosocial: perceived stress ≥ moderate (OR 5.67, 95% CI 3.15–10.23; p<0.001), daytime somnolence ≥ moderate (OR 5.10, 95% CI 1.70–15.31; p=0.004), physical pain affecting sleep (OR 4.54, 95% CI 2.41–8.57; p<0.001), and sleep medication use (OR 2.99, 95% CI 1.55–5.76; p=0.001). No laboratory or dialysis adequacy parameter remained independently associated after adjustment. Model discrimination was excellent (AUC=0.876).Sensitivity analysis excluding sleep medication confirmed robustness, with stress, pain, and daytime somnolence remaining the sole significant correlates of poor sleep. Psychosocial variables showed substantially stronger associations than all biological and dialysis-related parameters evaluated.
Conclusion
Psychosocial factors emerged as the strongest independent correlates of poor sleep quality, whereas traditional laboratory and dialysis adequacy parameters were not associated after adjustment. These findings support integrating structured psychosocial assessment into routine hemodialysis care and inform the design of future interventional studies targeting modifiable patient-reported factors.