Mediating Effects of Fatigue and Sleep Quality on Uremic Pruritus and Quality of Life Among Hemodialysis Patients: A Cross‐Sectional Study

INTRODUCTION: Uremic pruritus is a common and distressing symptom among patients undergoing hemodialysis, frequently accompanied by fatigue and poor sleep quality. These symptoms collectively impair quality of life (QoL), yet their interrelationships remain unclear. To examine whether fatigue and sleep quality mediate the relationship between uremic pruritus and QoL in hemodialysis patients. METHODS: A cross-sectional study using quantitative mediation analysis. A total of 175 hemodialysis patients from three hospital-affiliated dialysis centers in South Korea completed validated self-report measures assessing uremic pruritus, fatigue, sleep quality, and QoL. Mediation analysis was conducted using Baron and Kenny's framework, Sobel test, and bootstrapping. FINDINGS: Uremic pruritus was significantly correlated with fatigue (r = 0.30, p < 0.001) and sleep quality (r = 0.53, p < 0.001), and negatively correlated with QoL (r = -0.29, p < 0.001). Fatigue (B = -0.3, 95% CI: -0.5 to -0.1) and sleep quality (B = -0.2, 95% CI: -0.4 to -0.1) were significantly associated with both uremic pruritus and QoL. The final model accounted for 40% of the variance in QoL. CONCLUSIONS: Uremic pruritus indirectly affects QoL through its impact on fatigue and sleep quality. This suggests that its influence operates via interconnected symptoms rather than directly. The findings support the need for integrated symptom management approaches in dialysis care. Interventions targeting fatigue and sleep quality may be effective in reducing the burden of pruritus and improving daily functioning and well-being in patients undergoing hemodialysis. PREPRINT STATEMENT: This manuscript has not been previously published and is not under consideration elsewhere. If the manuscript is posted on a preprint server, the authors will update it with a link to the final published version. STATISTICAL COMPLIANCE STATEMENT: The statistics were checked prior to submission by an expert statistician, Ilhyun Lee, Email: tarra@statedu.com.