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This cluster significantly impairs patients\u2019 health-related quality of life and increases mortality risk. Although cross-sectional studies suggest interconnections, the temporal dynamics and interrelationships within this triad remain unclear, particularly regarding gender differences. Therefore, this study aimed to explore the temporal dynamics and longitudinal relationships among sleep quality, fatigue, and depressive symptoms in patients undergoing MHD.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A longitudinal survey of 242 MHD patients in Urumqi, Xinjiang, China, was conducted to examine the interrelationships between sleep quality, fatigue, and depressive symptoms using a cross-lagged panel model. The Pittsburgh Sleep Quality Index(PSQI), Functional Assessment of Chronic Illness Therapy-Fatigue(FACIT-F), and Self-Rating Depression Scale(SDS) were used for assessment at baseline (T1, December 2024 to February 2025) and at follow-up (T2, March 2025 to May 2025).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Cross-lagged analyses revealed a bidirectional longitudinal relationship between lower fatigue severity (higher FACIT-F scores) and lower depressive symptoms (lower SDS scores) (\u03b2 = -0.195,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&lt;\u20090.05; \u03b2 = -0.205,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&lt;\u20090.05, respectively). Furthermore, lower baseline fatigue (higher FACIT-F scores) was longitudinally associated with better subsequent sleep quality (lower PSQI scores) (\u03b2 = -0.227,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&lt;\u20090.01). Conversely, more severe baseline depressive symptoms (higher SDS scores) predicted poorer subsequent sleep quality (higher PSQI scores) (\u03b2\u2009=\u20090.260,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&lt;\u20090.01). Exploratory gender-stratified analyses revealed distinct patterns in these symptom dynamics.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>This study highlights the dynamic and reciprocal relationships among sleep quality, fatigue, and depressive symptoms in MHD patients. The reciprocal longitudinal associations between fatigue and depressive symptoms, and their links to subsequent sleep quality, underscore the importance of early identification and intervention. Interventions aimed at reducing fatigue and depressive symptoms, alongside sleep-focused strategies, may help improve sleep quality in MHD patients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Clinical trial number<\/jats:title>\n                    <jats:p>Not applicable.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s12882-026-04780-w","type":"journal-article","created":{"date-parts":[[2026,1,29]],"date-time":"2026-01-29T19:34:12Z","timestamp":1769715252000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["The relationship between sleep quality, fatigue, and depressive symptoms in maintenance hemodialysis patients: a cross-lagged analysis"],"prefix":"10.1186","volume":"27","author":[{"given":"Hong","family":"Tan","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"XiaoLan","family":"Ma","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"HuiZe","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"YiPei","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Li","family":"Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,1,29]]},"reference":[{"key":"4780_CR1","unstructured":"Saran R, Robinson B, Abbott KC, Agodoa LYC, Bragg-Gresham J, Balkrishnan R, Bhave N, Dietrich X, Ding Z, Eggers PW, et al. 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