Restless legs syndrome: an underappreciated and distressing problem for haemodialysis patients

Global prevalence of restless legs syndrome among hemodialysis patients: A systematic review and meta-analysis

OBJECTIVES

Restless legs syndrome (RLS) is a common complaint in patients undergoing hemodialysis (HD). Despite the fact that the estimated prevalence of RLS among HD patients is widely reported, these results varied significantly in the relevant literature. Due to this limitation, the aim of this study was to determine the global prevalence of RLS among HD patients.

METHODS

This systematic review was conducted and reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses 2020 statement. We searched the electronic databases: Cochrane Library, PubMed, Embase, Web of Science, Scopus, Cumulative Index to Nursing and Allied Health Literature, China Knowledge Resource Integrated Database, Wanfang Database, Chinese Biomedical Database, and Weipu Database. A random effects model was employed to calculate pooled prevalence rates.

RESULTS

The global pooled prevalence of RLS in HD patients was 27.2% (95% CI: 24.8-29.7). Stratified analyses demonstrated that included studies with sample size <100 had the highest pooled prevalence of RLS. The prevalence of RLS using clinical interviews and questionnaires was 28.7% (95% CI: 25.2-32.2) and 25.9% (95% CI: 22.8-29.1), respectively. RLS prevalence is higher in females (29.7%, 95% CI: 26.2-33.2) HD patients than in males (23.5%, 95% CI: 20.9-26.0), and the African region has the highest prevalence in the world when the diagnostic criteria were restricted to the 2003 version of International RLS Study Group criteria, the prevalence of RLS was highest (28.9%, 95% CI: 25.9-31.9).

CONCLUSION

Our results revealed a high RLS prevalence in HD patients worldwide. However, the prevalence of RLS among HD patients varied significantly based on sample size, data collection method, gender, diagnostic criteria, and geographical region.

Restless legs syndrome in end stage renal disease patients undergoing hemodialysis

BACKGROUND

The prevalence of Restless legs syndrome (RLS) in End Stage Renal Disease (ESRD) patients is higher than that in the general population. However, the associations of RLS within the ESRD population are inconsistent and RLS is usually neglected in dialysis centers, although it impairs the life quality among ESRD patients. We aim to investigate the prevalence of RLS in patients with ESRD undergoing maintenance hemodialysis and evaluate the risk factors of developing RLS and the effect of RLS on quality of life among ESRD patients.

METHODS

ESRD patients undergoing maintenance hemodialysis in Shanghai General Hospital dialysis unit from July 2016 to October 2016 were enrolled in the study. RLS was diagnosed according to the criteria of the International Restless Legs Syndrome Study Group (IRLSSG). IRLSSG Severity Scale was used to evaluate the severity of RLS. Pittsburgh Sleep Quality Index (PSQI) was used to evaluate sleep quality, and Hospital Anxiety and Depression Scale (HADS) was used to estimate anxiety and depression. Serologic and historic variables were analyzed to determine predictors of RLS in the ESRD population.

RESULTS

A total of 137 ESRD patients were enrolled. The prevalence of RLS among the ESRD patients was 20.44%. The risk of RLS was increased significantly in females (OR = 2.729, p = 0.032) and daily alcohol drinkers (OR = 4.716, p = 0.022). RLS increased the risks of sleep disorders (25/28, 89.3% vs 73/109, 67.0%, p = 0.02) and sedative hypnotics intake (7/28, 25.0% vs 10/109, 9.2%, p = 0.047) and impaired the sleep quality (7/109 vs 11/28, p = 0.001) according to PSQI sum scores.

CONCLUSION

A high RLS prevalence among the ESRD patients undergoing hemodialysis was confirmed. ESRD patients who are women and drinking alcohol have a higher risk of RLS. The sleep quality was significantly impaired and sleeping medication use was more common among the ESRD patients with RLS.

The association between the prevalence of restless leg syndrome, fatigue, and sleep quality in patients undergoing hemodialysis

OBJECTIVE

To determine the prevalence of restless legs syndrome (RLS) in patients with chronic renal failure (CRF) and to compare CRF patients with or without RLS in terms fatigue and sleep quality.

METHODS

A cross-sectional study was conducted on 220 patients (18-75 years) who were undergoing dialysis 3 times weekly in Çorum Province, Corum, Turkey, between January 2014 and January 2016. The diagnosis of RLS was based on the diagnostic form proposed by the international RLS study group. Sleep quality was evaluated using the Pittsburgh sleep quality index (PSQI), and severity of fatigue was determined by using fatigue severity scale (FSS).

RESULTS

Of all the participants, 16.8% (n= 37) (Group 1) were found to have RLS, while 183 patients had no RLS (Group 2). The mean ages were similar between groups. With respect to laboratory analyses, a p-value of less than 0.05 was considered in Group 1 than in Group 2. Restless legs syndrome was mild (7.1%), moderate (46.4%) and severe (39.3%) in patients with RLS. Factors associated with the severity of RLS included weight, duration of dialysis, anuria, iron, total iron binding capacity, calcium and transferrin saturation. The PSQI and FSS scores were significantly worse in Group 1 (p less than 0.001).

CONCLUSION

Restless legs syndrome is a common condition in patients undergoing hemodialysis; the results of our study confirm the adverse effects of RLS in terms of many aspects of sleep quality and fatigue.

Effects of Hemodialysis on Visual Pathways Assessed by Visual Evoked Potentials (VEPs)

Introduction

Uremia is a metabolic disorder that affects the functions of the central nervous system (CNS). Visual evoked potentials (VEPs) can be used to demonstrate uremia-induced effects on the CNS. Data on VEPs of patients with chronic renal failure (CRF) are limited. The purpose of this study was to examine the effects of renal failure and the ultrafiltration rate (UFR) on CNS functions in patients undergoing hemodialysis (HD) using VEPs.

Methods

The study consisted of 30 CRF patients undergoing HD, and a control group of 28 individuals, matched in terms of age and gender. Patients with mental retardation, diabetes mellitus, demyelinating disease, stroke, use of neurotoxic drugs, and ophthalmologic diseases were excluded from the study. The pattern VEP (PVEP) parameters recorded were latencies to N75 (N1), P100 (P1) and N135 (N2) waves, and the peak-to-peak amplitude of a P100 wave. The PVEP was taken twice just before and 24 h after HD, and the PVEP parameters were compared. Additionally, the effect of the UFR on the PVEP parameters was examined.

Results

There was no difference between the HD group and control group in terms of gender and age (mean ages of 49.56±12.52 and 48.53±13.28 years, respectively). The average HD period was 87.53±56.34 months. The P1 latencies between the two eyes the patients with CRF were prolonged when compared to those of the controls (right eye p=0.002; left eye p=0.019). A single HD session significantly shortened the latency of the P1 waves compared to that of the baseline waves (p<0.000). Additionally, there was a positive correlation between the difference in the P1 latency before and after HD and the UFR (right eye p=0.03, r=0.525; left eye p=0.022, r=0.417, respectively).

Conclusion

We conclude that VEP, which is an easy, cheap, and simple electrophysiological method, can be used to determine subclinical CNS dysfunction in patients with CRF and show the effect of fluid removal during HD on the visual pathways, and to show the corrective effect of effective fluid imaging on the visual pathways.

Psychiatric comorbidities in movement disorders

Psychiatric comorbidities are common in movement disorders. This review provides a practical approach to help clinicians to recognize psychiatric disorders in the most frequent movement disorders. However, the extent of neurodegeneration, as well as the impact of medications with considerable CNS effects, influences the diverse psychiatric presentations that, in turn, are influenced by the stress of living with a movement disorder. Depression, anxiety, and psychosis are the most common psychiatric comorbidities in movement disorders and of the medications used to treat the motor disturbances. These psychiatric problems impair patients' functioning throughout the course of the chronic neurodegenerative diseases. Due to the direct connection between brain dysfunction and psychiatric symptoms, there is hope that understanding the psychiatric comorbidities in movement disorders will lead to a better quality-of-life.