Sleep disturbance in CKD: patient‑prioritized outcomes, management, and perceptions – a multicenter mixed-methods study in Australia

BACKGROUND: Sleep disturbances are common in chronic kidney disease (CKD), yet patient priorities, reporting behaviors, and experiences of sleep management remain poorly understood. This study explored perceived causes of sleep disturbance, patient-prioritized sleep outcomes, and experiences of reporting and managing sleep problems. METHODS: A multicenter, convergent mixed-methods study of adults with CKD stage 4-5, including those receiving kidney replacement therapy. Participants were recruited from four nephrology units across three Australian states. Survey data were analyzed using descriptive statistics and subgroup comparison, and interview data using thematic analysis, with findings integrated through triangulation. RESULTS: A total of 234 participants completed the survey and 14 participated in interviews. Participants were predominantly male (67%), aged over 60 years, and receiving hemodialysis (62%). Overall, 73% were classified as poor sleepers. Fragmented sleep (56%), nocturia (44%), and restless legs syndrome (27%) were the most common contributors. Feeling refreshed on waking and satisfaction with sleep were the highest-priority outcomes, ranked above social participation, ability to work, and hospital admissions. Forty-one percent reported that their treating team had never asked about sleep, and among those who raised concerns, almost one-quarter received no management. Pharmacological therapy was the most commonly reported clinical management (33%), despite a preference for nonpharmacological strategies. Nine percent used a wearable sleep tracker; with a further 41% willing to try one. CONCLUSION: In this cohort, sleep disturbances were common, under-recognised, and inconsistently managed. Management approach does not fully align with patient preferences. Greater access to nonpharmacological approaches and wearable technologies may support monitoring and engagement.