Aims: To determine factors associated with poor sleep quality among patients with pre-dialysis chronic kidney disease. Design: This is a systematic review study guided by Preferred Reporting Items for Systematic Reviews and Meta-Analyses statements and checklist. Data Sources: Empirical evidence was sought in major electronic databases, including Embase, MEDLINE, CINAHL and Airiti library from March to September 2022. Review Methods: Studies investigating factors associated with poor sleep quality among adult patients with chronic kidney disease were included. Study participants who received renal replacement therapy and had sleep disorders and serious illnesses such as cancer were excluded. Of the 526 studies that resulted from the search after removing duplicate articles, 20 studies were assessed for quality by using Joanna Briggs Institute and Newcastle-Ottawa Scale by two doctorial prepared nursing scientists.Results: A total of 20 studies were included in this review. The prevalence of poor sleep quality in these studies ranged from 11% to 97.5%. Demographics (older age and female), physiological conditions (higher body mass index, higher hip circumferences, higher systolic blood pressure, poor cardiovascular function, dyspnoea, pain, cramps, itchiness or moderate to extreme pruritus, lower fasting plasma glucose, electrolyte imbalance, higher total cholesterol and gastrointestinal symptoms), depression, smoking, arousal-related and cognitive arousal behaviours were associated with poor sleep quality. Conclusion: Poor sleep quality was prevalent and influenced kidney function, increased mortality as well as decreased quality of life in patients with pre-dialysis chronic kidney disease. This review synthesizes factors associated with poor sleep quality. Managing these factors can mitigate and prevent poor sleep quality. Impact: Healthcare providers, especially nurses, can assess the risk factors of poor sleep quality and reinforce patients' self-management. Future research should elucidate the assessment and management of risk factors and transfer these into widespread use in the routine care of patients with chronic kidney disease.

Adherence to healthy behaviors is a protective factor in the disease progression of chronic kidney disease (CKD). Measuring adherence can lead to the recognition of unhealthy behaviors and the suggestion of programs to prevent poor health outcomes. An assessment measurement for patients with CKD not requiring dialysis was developed and psychometrically tested. A convenience sample ( n = 330) of patients with CKD attending a nephrology clinic in southern Taiwan completed the 13-item Adherence to Healthy Behaviors Scale (AHBS). A principal axis factor analysis and a parallel analysis demonstrated a three-factor structure accounting for 47.16% of the total variance. Confirmatory factor analysis indicated a good model fit. The criterion-related validity was adequate ( r = .51; p < .000), with a Cronbach’s alpha of .70; the test-retest reliability demonstrated good stability ( r = .70; p < .000). The AHBS is a valid, reliable instrument to assess adherence to healthy behaviors among patients with CKD.

Patients with hemodialysis commonly experience multiple symptoms. Most of the previous studies analyzedthe symptoms as one dimension such as the severity dimension. Conducting the comprehensive symptomassessment among patients with hemodialysis is necessary to gain a better understanding of the symptom burden.The aim of this study was to identify symptom burden among patients with hemodialysis comprehensively.This study was a descriptive study. A convenience sample of 320 patients undergoing hemodialysis was recruitedfrom the dialysis units at two referral hospitals in Indonesia (Fatmawati Hospital and Cipto MangunkusumoNational Hospital). Indonesian Version of Chronic Kidney Disease – Symptom Burden Index (CKD-SBI) wasused. For the data analysis, descriptive analysis was used. Total 320 subjects were collected. This study foundthat lack of energy was the highest physical symptom burden under 4 dimensions: occurrence 269 (84.0%),severity (mean = 4.28, SD = 3.08), distress (mean = 4.42, SD = 3.09), and frequency (mean = 4.41, SD = 3.27).Furthermore, decreased interest in sex was the highest psychological symptom burden under for dimensions:occurrence 210 (65.6%), severity (mean = 3.39, SD = 3.38), distress (mean = 2.92, SD = 2.99), frequency(mean = 3.70, SD = 3.65). Lack of energy and decreased interest in sex were consistently the highest symptomburden among patients with hemodialysis. Creating appropriate interventions and managing the symptomsexperienced by patients with hemodialysis comprehensively is very important to improve their quality of life.