Risk Factors for Restless Legs Syndrome in Dialysis Patients

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Abstract

Background: Restless legs syndrome (RLS) is a movement disorder that affects 6.6–62% of dialysis patients. The aims of this multicentre cross-sectional study were to document the frequency, prevalence and severity of RLS in patients attending 5 dialysis centres for chronic hospital haemodialysis (HHD) and to identify associated risk factors. Methods: Thediagnosis of RLS was made using the criteria of The International Restless Legs Study Group. The following data were collected: age; gender; duration of renal replacement therapy (RRT); current smoking status; urea reduction ratio; weekly erythropoietin dose; weekly intravenous iron dose; prescribed beta blocker; prescribed renin/angiotensin system inhibitors and pre-dialysis blood concentrations of haemoglobin, ferritin, total calcium (corrected for albumin), albumin, phosphate, parathyroid hormone. Associations with RLS were analysed by univariate and multivariate logistic regression. Results: Data relating to 277 of 295 patients who had been attending for regular HHD for >3 months were collected. RLS was present in 127 (45.8%). 82 (29.6%), 27 (9.7%) and 18 (6.5%) patients had mild, moderate and severe RLS, respectively. 39 patients (14.1%) were prescribed medicines aimed at reducing RLS. 30 (76.9%) of these 39 patients still had RLS. Female gender (RR 2.17; p = 0.01), increasing duration since first dialysis (RR 1.06 per year; p = 0.03) and increasing body weight(RR 1.02 per kg; p = 0.02) were independent risk factors for RLS by multivariate analysis. In contrast to previous studies, we found no association with iron status, haemoglobin, serum phosphate or smoking. Conclusions: There is a high prevalence of RLS in our population and therapeutic intervention appears to have limited efficacy. The associations with female gender, duration of RRT and body weight deserve further study.

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Prevalence of restless legs syndrome and periodic limb movement disorder in the general population.

Maurice M Ohayon, Thomas Roth (2002)

Periodic limb movement disorder (PLMD) and restless legs syndrome (RLS) are two sleep disorders characterized by abnormal leg movements and are responsible for deterioration in sleep quality. However, the prevalence of these disorders is not well known in the general population. This study aims to document the prevalence of RLS and PLMD in the general population and to identify factors associated with these conditions. Cross-sectional studies were performed in the UK, Germany, Italy, Portugal and Spain. Overall, 18,980 subjects aged 15 to 100 years old representative of the general population of these five European countries underwent telephone interviews with the Sleep-EVAL system. A section of the questionnaire assessed leg symptoms during sleep. The diagnoses of PLMD and RLS were based on the minimal criteria provided by the International Classification of Sleep Disorders. The prevalence of PLMD was 3.9% and RLS was 5.5%. RLS and PLMD were higher in women than in men. The prevalence of RLS significantly increased with age. In multivariate models, being a woman, the presence of musculoskeletal disease, heart disease, obstructive sleep apnea syndrome, cataplexy, doing physical activities close to bedtime and the presence of a mental disorder were significantly associated with both disorders. Factors specific to PLMD were: being a shift or night worker, snoring, daily coffee intake, use of hypnotics and stress. Factors solely associated with RLS were: advanced age, obesity, hypertension, loud snoring, drinking at least three alcoholic beverages per day, smoking more than 20 cigarettes per day and use of SSRI. PLMD and RLS are prevalent in the general population. Both conditions are associated with several physical and mental disorders and may negatively impact sleep. Greater recognition of these sleep disorders is needed.

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Epidemiology of restless legs symptoms in adults.

Susan Young, Wayne Hening, C Purvis … (2000)

Restless legs syndrome (RLS) is a disorder characterized by sleep-disrupting unpleasant leg sensations, often accompanied by daytime behavioral problems. Treatment for this condition is available, but it is suspected that most instances of RLS remain undiagnosed. The goal of this investigation was to assess the prevalence and health status correlates of restless legs symptoms (hereinafter referred to as restless legs) in the general population. A question reflecting the clinical features of RLS was added to the 1996 Kentucky Behavioral Risk Factor Surveillance Survey. Data on the frequency of experiencing restless legs, self-rated general and mental health status, demographics, and behavioral risk factors were collected by telephone interview from 1803 men and women, 18 years and older. Experiencing restless legs 5 or more nights per month was reported by 3% of participants aged 18 to 29 years, 10% of those aged 30 to 79 years, and 19% of those 80 years and older. The age-adjusted prevalence for Kentucky adults is 10.0%; prevalence did not vary significantly by sex. The adjusted odds ratios (95% confidence intervals) for restless legs and diminished general health and poor mental health status were 2.4 (1.4-4.0) and 3.1 (2.0-4.6), respectively. Restless legs were significantly associated with increased age and body mass index, lower income, smoking, lack of exercise, low alcohol consumption, and diabetes. The prevalence of restless legs in the general adult population is high. Restless legs may be associated with decreased well-being, emphasizing the need for further research and greater medical recognition of this condition.

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Restless legs syndrome in end-stage renal disease.

J Lazarus, Warren J Winkelman, Glenn Chertow (1996)

The aim of this study was to evaluate the prevalence of restless legs syndrome (RLS) in patients with end-stage renal disease (ESRD), and to determine its association with sleep disorders and premature discontinuation of dialysis ("sign-offs"). End-stage renal disease patients (N = 204) and a control group of patients with heart disease (N = 129) completed a self-administered questionnaire regarding symptoms of RLS, sleep habits, pruritus, and adherence to dialysis therapy. Laboratory measures and sensory nerve amplitudes were collected on the ESRD patients. Twenty percent of the ESRD patients and 6% of the cardiac patients reported moderate to severe RLS symptomatology. Sleep onset was delayed and total sleep time was diminished in ESRD patients compared with cardiac patients. Symptoms of RLS were directly correlated with all sleep measures as well as with pruritus. Symptoms of RLS, sleep onset latency, and transferrin saturation were independently associated with premature discontinuation of dialysis. Significantly increased risk for mortality was observed in patients with RLS at the 2.5-year follow-up. Restless legs syndrome is a common finding in patients with ESRD and is associated with substantial morbidity.

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Author and article information

Journal

Journal ID (publisher-id): NEC

Journal ID (nlm-ta): Nephron Clin Pract

Journal ID (doi): 10.1159/issn.1660-2110

Title: Nephron Clinical Practice

Publisher: S. Karger AG

ISSN (Electronic): 1660-2110

Publication date Subscription-year: 2005

Publication date (Print): November 2005

Publication date (Electronic): 15 July 2005

Volume: 101

Issue: 3

Pages: c155-c160

Affiliations

^aRenal Unit, Glasgow Royal Infirmary, Glasgow; ^bDepartment of Nephrology, Institute of Human Genetics, Newcastle-upon-Tyne; ^cRenal Unit, Western Infirmary, Glasgow, UK

Article

Publisher ID: 87073 Other ID: Nephron Clin Pract 2005;101:c155–c160

DOI: 10.1159/000087073

PubMed ID: 16020954

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