Does Ultrafiltration Rate Influence Sleep Quality Among Hemodialysis Patients

Introduction: Sleep disturbances are common in hemodialysis (HD) patients. We examined the excessive ultrafiltration rate (UFR), which is associated with poor outcomes, for its possible impact on sleep quality. Methods: Only oligo-anuric patients with a three-times-weekly HD schedule were included in the study. Pittsburgh Sleep Quality Index (PSQI) was used to assess sleep quality and a score> 5 indicated poor sleepers. Ultrafiltration values refer to the month preceding the PSQI survey. Patients were divided into three categories: optimal UFR group (<10 mL/kg/h), borderline UFR group (10-13 mL/kg/h), and high UFR group (≥13 mL/kg/h). Results: A total of 102 patients were included, with a median age of 60(46–67) years. Median time of undergoing dialysis was 44.5(22–77) months. Average interdialytic weight gain (IDWG) percentage was 4.7(3.7–5.7) and UFR was 11.6±3.5 mL/kg/h. 37 patients (36.3%) had optimal UFR, 29 patients (28.4%) had borderline UFR, 36 patients (35,3%) had high UFR. Average PSQI score was 7 points (4–10) and 61 patients (59.8%) was identified as poor sleepers. Mean UFR was 11.7±3.4 mL/kg/h in poor sleepers and 11.5±3.7 mL/kg/h in non-poor sleepers (p=0. 819). PSQI score and poor sleeper prevalence were not significantly different between UFR groups. There was no significant correlation between PSQI and UFR (p=0.325). In multivariate regression analysis, UFR was not an independent predictor of sleep quality. Additionally, younger age and a long history of HD were independent predictors of high UFR. Conclusion: Excessive and rapid fluid removal does not constitute a risk for poor sleep quality. Also, current findings underscore the increased frequency and complexity of sleep disorders in dialysis patients.