Work

An interpretable nomogram for predicting sleep disturbance risk in maintenance hemodialysis patients

Year: 2026

Type: article

Abstract: BACKGROUND: This study aimed to develop and validate an interpretable nomogram to predict the risk of sleep disturbance in maintenance hemodialysis (MHD) patients. METHODS: In this single-center study, 208 MHD patients were enrolled. Sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI), with a score > 5 defining the sleep disorder group. Univariate and multivariable logistic regression analyses identified independent predictors, which were used to construct a nomogram. The model's performance was evaluated by the area under the receiver operating characteristic curve (AUC), calibration plot, and decision curve analysis (DCA). Explainable AI (SHapley Additive exPlanations, SHAP) was applied to interpret the model. RESULTS: Among 208 patients, 144 (69.2%) had sleep disturbance. Multivariable analysis identified restless legs syndrome (RLS) (OR = 4.52, 95% CI: 2.22-9.18), older age (OR = 1.04, 95% CI: 1.01-1.07), lower serum albumin (Alb) (OR = 0.86, 95% CI: 0.77-0.96), and lower parathyroid hormone (PTH) (OR = 0.99, 95% CI: 0.99-0.99) as independent predictors. Primary kidney disease etiology was retained for clinical comprehensiveness. The nomogram incorporating these five predictors demonstrated good discrimination (AUC = 0.80, 95% CI: 0.73-0.86), satisfactory calibration, and positive net benefit on DCA. SHAP analysis confirmed RLS as the most influential predictor and revealed complex, non-linear relationships for Alb and PTH. CONCLUSION: This study presents a validated, interpretable nomogram that is associated with the individual risk of sleep disturbance in MHD patients using five readily available clinical parameters. The tool demonstrates good performance and clinical utility, potentially facilitating early identification and personalized management of high-risk individuals.

Source: International Urology and Nephrology

DOI: 10.1007/s11255-026-05091-7

Authors: Haixia Zhang, Linsen Jiang, Rong Ni, Peng Qian, Zhi Wang, Weiwei Li

Institution: Second Affiliated Hospital of Soochow University

Language: English

Topic: Sleep and related disorders

Subfield: Experimental and Cognitive Psychology

Field: Psychology

Domain: Social Sciences

SDG: Good health and well-being

Open Access status: hybrid

Estimated APC paid: $3,690