J Clin Neurol.  2008 Dec;4(4):153-157. 10.3988/jcn.2008.4.4.153.

Restless Legs Syndrome in Patients on Hemodialysis: Symptom Severity and Risk Factors

• Kim JM
• Kwon HM
• Lim CS
• Kim YS
• Lee SJ
• Nam H

• KMID: 2287668
• DOI: http://doi.org/10.3988/jcn.2008.4.4.153

Abstract

BACKGROUND AND PURPOSE
Restless legs syndrome (RLS) is a sleep disorder that frequently occurs in dialysis patients, which disturbs the sleep and reduces the quality of life. The aim of this study was to determine the risk factors for RLS in dialysis patients. METHODS: Patients who visited any of four outpatient dialysis clinics between September 2005 and May 2006 were included in this study. The diagnosis of RLS and the severity assessment were made using the criteria described by the International Restless Legs Syndrome Study Group. We collected basic demographic data, clinical information, and laboratory findings, and then analyzed their association with various aspects of RLS using univariate and multivariate analyses. RESULTS: RLS was present in 46 (28.0%) of 164 dialysis patients. We found no significant risk factor for inducing RLS. The predialysis serum blood urea nitrogen (BUN) level in the dialysis patients with RLS was significantly correlated with RLS symptom severity. CONCLUSIONS: Predialysis BUN is related to RLS symptom severity. Further studies on the underlying mechanism are needed.

Keyword

restless legs syndrome; hemodialysis; blood urea nitrogen

MeSH Terms

Blood Urea Nitrogen
Dialysis
Humans
Multivariate Analysis
Outpatients
Quality of Life
Renal Dialysis
Restless Legs Syndrome
Risk Factors

Figure

• 

  Fig. 1 The predialysis blood urea nitrogen (BUN) level was significantly correlated with scores on the IRLSSG (International Restless Legs Syndrome Study Group) Rating Scale.

Reference

1. Walters AS. Toward a better definition of the restless legs syndrome. The International Restless Legs Syndrome Study Group. Mov Disord. 1995. 10:634–642.

2. Kavanagh D, Siddiqui S, Geddes CC. Restless legs syndrome in patients on dialysis. Am J Kidney Dis. 2004. 43:763–771.

3. Merlino G, Piani A, Dolso P, Adorati M, Cancelli I, Valente M, et al. Sleep disorders in patients with end-stage renal disease undergoing dialysis therapy. Nephrol Dial Transplant. 2006. 21:184–190.

4. Bhowmik D, Bhatia M, Gupta S, Agarwal SK, Tiwari SC, Dash SC. Restless legs syndrome in haemodialysis patients in India: a case controlled study. Sleep Med. 2003. 4:143–146.

5. Hui DS, Wong TY, Ko FW, Li TS, Choy DK, Wong KK, et al. Prevalence of sleep disturbances in Chinese patients with end-stage renal failure on continuous ambulatory peritoneal dialysis. Am J Kidney Dis. 2000. 36:783–788.

6. Berger K, Kurth T. RLS epidemiology--frequencies, risk factors and methods in population studies. Mov Disord. 2007. 22:Suppl 18. s420–s423.

7. Castillo PR, Kaplan J, Lin SC, Fredrickson PA, Mahowald MW. Prevalence of restless legs syndrome among native South Americans residing in coastal and mountainous areas. Mayo Clin Proc. 2006. 81:1345–1347.

8. Winkelman JW, Chertow GM, Lazarus JM. Restless legs syndrome in end-stage renal disease. Am J Kidney Dis. 1996. 28:372–378.

9. Unruh ML, Levey AS, D'Ambrosio C, Fink NE, Powe NR, Meyer KB, et al. Restless legs symptoms among incident dialysis patients: association with lower quality of life and shorter survivial. Am J Kidney Dis. 2004. 43:900–909.

10. Mucsi I, Molnar MZ, Ambrus C, Szeifert L, Kovacs AZ, Zoller R, et al. Restless legs syndrome, insomnia and quality of life in patients on maintenance dialysis. Nephrol Dial Transplant. 2005. 20:571–577.

11. Walters AS, LeBrocq C, Dhar A, Hening W, Rosen R, Allen RP, et al. Validation of the International Restless Legs Syndrome Study Group rating scale for restless legs syndrome. Sleep Med. 2003. 4:121–132.

12. Kim J, Choi C, Shin K, Yi H, Park M, Cho N, et al. Prevalence of restless legs syndrome and associated factors in the Korean adult population: the Korean Health and Genome Study. Psychiatry Clin Neurosci. 2005. 59:350–353.

13. Takaki J, Nishi T, Nangakku M, Shimoyama H, Inada T, Matsuyama N, et al. Clinical and psychological aspects of restless legs syndrome in uremic patients on hemodialysis. Am J Kidney Dis. 2003. 41:833–839.

14. Miranda M, Araya F, Castillo JL, Durán C, González F, Arís L. [Restless legs syndrome: a clinical study in adult general population and in uremic patients]. Rev Med Chil. 2001. 129:179–186.

15. Gigli GL, Adorati M, Dolso P, Piani A, Valente M, Brotini S, et al. Restless legs syndrome in end-stage renal disease. Sleep Med. 2004. 5:309–315.

16. Locatelli F, Buoncristiani U, Canaud B, Köhler H, Petitclerc T, Zucchelli P. Dialysis dose and frequency. Nephrol Dial Transplant. 2005. 20:285–296.

17. Siddiqui S, Kavanagh D, Traynor J, Mak M, Deighan C, Geddes C. Risk factors for restless legs syndrome in dialysis patients. Nephron Clin Pract. 2005. 101:c155–c160.

18. Rothdach AJ, Trenkwalder C, Haberstock J, Keil U, Berger K. Prevalence and risk factors of RLS in an elderly population: the MEMO study. Memory and Morbidity in Augsburg Elderly. Neurology. 2000. 54:1064–1068.

19. Kawauchi A, Inoue Y, Hashimoto T, Tachibana N, Shirakawa S, Mizutani Y, et al. Restless legs syndrome in hemodialysis patients: health-related quality of life and laboratory data analysis. Clin Nephrol. 2006. 66:440–446.

20. Kageyama T, Kabuto M, Nitta H, Kurokawa Y, Taira K, Suzuki S, et al. Prevalence of periodic limb movement-like and restless legs-like symptoms among Japanese adults. Psychiatry Clin Neurosci. 2000. 54:296–298.

21. Phillips B, Young T, Finn L, Asher K, Hening WA, Purvis C. Epidemiology of restless legs symptoms in adults. Arch Intern Med. 2000. 160:2137–2141.

22. Telarović S, Relja M, Trkulja V. Restless legs syndrome in hemodialysis patients: association with calcium antagonists. A preliminary report. Eur Neurol. 2007. 58:166–169.

23. Holmes R, Tluk S, Metta V, Patel P, Rao R, Williams A, et al. Nature and variants of idiopathic restless legs syndrome: observations from 152 patients referred to secondary care in the UK. J Neural Transm. 2007. 114:929–934.

24. Cho YW, Lee H, Lee JH, Han SY, Lee MY. Sleep disorders in Maintenance dialysis patients with end-stage renal disease. J Korean Neurol Assoc. 2003. 21:492–497.

25. Cirignotta F, Mondini S, Santoro A, Ferrari G, Gerardi R, Buzzi G. Reliability of a questionnaire screening restless legs syndrome in patients on chronic dialysis. Am J Kidney Dis. 2002. 40:302–306.