Original Report: Patient-Oriented, Translational Research
Survival of Dialysis Patients with Restless Legs Syndrome: A 15-Year Follow-Up StudyBaiardi S.a, b · Mondini S.a · Baldi Antognini A.c · Santoro A.d · Cirignotta F.a, b
aNeurology Unit, S. Orsola-Malpighi Hospital, AOU Bologna, and bDIBINEM-Department of Biomedical and Neuromotor Sciences, cDepartment of Statistical Sciences, University of Bologna, and dNephrology Unit, S. Orsola-Malpighi Hospital, AOU Bologna, Bologna, Italy
Do you have an account?
- Rent for 48h to view
- Buy Cloud Access for unlimited viewing via different devices
- Synchronizing in the ReadCube Cloud
- Printing and saving restrictions apply
Rental: USD 8.50
Cloud: USD 20.00
Article / Publication Details
Background: Restless legs syndrome, also known as Willis/Ekbom disease (RLS/WED), is a sleep-related, sensorimotor disorder with a high prevalence among end-stage renal disease (ESRD) patients undergoing haemodialysis (HD) (about 15-40%). Whether RLS/WED in uremic patients influences cardiovascular morbidity and mortality remains a matter of controversy. The aim of this study was to evaluate the relationship of RLS/WED and mortality in a population of chronically dialyzed patients. Method: In 1996, we studied 128 patients with ESRD undergoing HD; 47 subjects (36.7%) complained RLS/WED symptoms. Fifteen years later we evaluated the mortality of this population. No clinical follow-up examination of the uremic population was made. The Kaplan-Maier curves in dialysis patients with or without RLS/WED (control group matched for age) were constructed for all-cause mortality and compared using log-rank test. Results: The Kaplan-Maier curves disclosed a lower mortality rate in the uremic patients with RLS/WED than in those without RLS/WED (p = 0.04). In our analysis, the mortality rate was not influenced by RLS/WED severity (p = 0.11) or gender (p = 0.15). No difference among the causes of death was found in the 2 groups. Conclusions: Our study suggests that mortality in ESRD patients is not influenced by concomitant RLS/WED. After a 15-year follow-up, survival rates in our cohort were significantly longer in uremic subjects with RLS/WED than in those without RLS/WED. Finally, we found no relationship between RLS/WED severity and mortality.
© 2017 S. Karger AG, Basel
- Allen RP, Picchietti D, Hening WA, Trenkwalder C, Walters AS, Montplaisi J; Restless Legs Syndrome Diagnosis and Epidemiology workshop at the National Institutes of Health; International Restless Legs Syndrome Study Group: Restless legs syndrome: diagnostic criteria, special considerations, and epidemiology. A report from the restless legs syndrome diagnosis and epidemiology workshop at the National Institutes of Health. Sleep Med 2003;4:101-119.
- Hening WA, Allen RP, Chaudhuri KR, Hornyak M, Lee HB, Winkelman J, Yoakum R: Clinical significance of RLS. Mov Disord 2007;22(suppl 18):S395-S400.
- Garcia-Borreguero D, Ferini-Strambi L, Kohnen R, O'Keeffe S, Trenkwalder C, Högl B, Benes H, Jennum P, Partinen M, Fer D, Montagna P, Bassetti CL, Iranzo A, Sonka K, Williams AM; European Federation of Neurological Societies; European Neurological Society; European Sleep Research Society: European guidelines on management of restless legs syndrome: report of a joint task force by the European Federation of Neurological Societies, the European Neurological Society and the European Sleep Research Society. Eur J Neurol 2012;19:1385-1396.
- Allen RP, Picchietti DL, Garcia-Borreguero D, Ondo WG, Walters AS, Winkelman JW, Zucconi M, Ferri R, Trenkwalder C, Lee HB; International Restless Legs Syndrome Study Group: Restless legs syndrome/Willis-Ekbom disease diagnostic criteria: updated International Restless Legs Syndrome Study Group (IRLSSG) consensus criteria - history, rationale, description, and significance. Sleep Med 2014;15:860-873.
American Academy of Sleep Medicine: International Classification of sleep disorders, in Darien IL (ed): American Academy of Sleep Medicine Publishing, 3rd edition (ICSD-3), 2014, pp 282-291.
- Winkelman JW, Chertow GM, Lazarus JM: Restless legs syndrome in end-stage renal disease. Am J Kidney Dis 1996;28:372-378.
- Collado-Seidel V, Kohnen R, Samtleben W, Hillebrand GF, Oertel WH, Trenkwalder C: Clinical and biochemical findings in uremic patients with and without restless legs syndrome. Am J Kidney Dis 1998;31:324-328.
- Unruh ML, Levey AS, D'Ambrosio C, Fink NE, Powe NR, Meyer KB; Choices for Healthy Outcomes in Caring for End-Stage Renal Disease (CHOICE) Study: Restless legs symptoms among incident dialysis patients: association with lower quality of life and shorter survival. Am J Kidney Dis 2004;43:900-909.
- Gigli GL, Adorati M, Dolso P, Piani A, Valente M, Brotini S, Budai R: Restless legs syndrome in end-stage renal disease. Sleep Med 2004;5:309-315.
- Merlino G, Piani A, Dolso P, Adorati M, Cancelli I, Valente M, Gigli GL: Sleep disorders in patients with end-stage renal disease undergoing dialysis therapy. Nephrol Dial Transplant 2006;21:184-190.
- La Manna G, Pizza F, Persici E, Baraldi O, Comai G, Cappuccilli ML, Centofanti F, Carretta E, Plazzi G, Colì L, Montagna P, Stefoni S: Restless legs syndrome enhances cardiovascular risk and mortality in patients with end-stage kidney disease undergoing long-term haemodialysis treatment. Nephrol Dial Transplant 2011;26:1976-1983.
- Schormair B, Plag J, Kaffe M, Gross N, Czamara D, Samtleben W, Lichtner P, Ströhle A, Stefanidis I, Vainas A, Dardiotis E, Sakkas GK, Gieger C, Müller-Myhsok B, Meitinger T, Heemann U, Hadjigeorgiou GM, Oexle K, Winkelmann J: MEIS1 and BTBD9: genetic association with restless leg syndrome in end stage renal disease. J Med Genet 2011;48:462-466.
- Giannaki CD, Sakkas GK, Karatzaferi C, Hadjigeorgiou GM, Lavdas E, Liakopoulos V, Tsianas N, Koukoulis GN, Koutedakis Y, Stefanidis I: Evidence of increased muscle atrophy and impaired quality of life parameters in patients with uremic restless legs syndrome. PLoS One 2011;6:e25180.
- Giannaki CD, Hadjigeorgiou GM, Karatzaferi C, Pantzaris MC, Stefanidis I, Sakkas GK: Epidemiology, impact, and treatment options of restless legs syndrome in end-stage renal disease patients: an evidence-based review. Kidney Int 2014;85:1275-1282.
- Mao S, Shen H, Huang S, Zhang A: Restless legs syndrome in dialysis patients: a meta-analysis. Sleep Med 2014;15:1532-1538.
- Lin CH, Wu VC, Li WY, Sy HN, Wu SL, Chang CC, Chiu PF, Lion HH, Lin CY, Chang HW, Lin SY, Wu KD, Chen YM, Wu RM: Restless legs syndrome in end-stage renal disease: a multicenter study in Taiwan. Eur J Neurol 2013;20:1025-1031.
- Takaki J, Nishi T, Nangaku M, Shimoyama H, Inada T, Matsuyama N, Kumano H, Kuboki T: Clinical and psychological aspects of restless legs syndrome in uremic patients on hemodialysis. Am J Kidney Dis 2003;41:833-839.
- Marconi S, Scaglione C, Pizza F, Rizzo G, Plazzi G, Vetrugno R, La Manna G, Campieri C, Stefoni S, Montagna P, Martinelli P: Group I nonreciprocal inhibition in restless legs syndrome secondary to chronic renal failure. Parkinsonism Relat Disord 2012;18:362-366.
- Winkelman JW, Shahar E, Sharief I, Gottlieb DJ: Association of restless legs syndrome and cardiovascular disease in the Sleep Heart Health Study. Neurology 2008;70:35-42.
- Li Y, Walters AS, Chiuve SE, Rimm EB, Winkelman JW, Gao X: Prospective study of restless legs syndrome and coronary heart disease among women. Circulation 2012;126:1689-1694.
- Li Y, Wang W, Winkelman JW, Malhotra A, Ma J, Gao X: Prospective study of restless legs syndrome and mortality among men. Neurology 2013;81:52-59.
- Molnar MZ, Lu JL, Kalantar-Zadeh K, Kovesdy CP: Association of incident restless legs syndrome with outcomes in a large cohort of US veterans. J Sleep Res 2016;25:47-56.
- Portaluppi F, Cortelli P, Buonaura GC, Smolensky MH, Fabbian F: Do restless legs syndrome (RLS) and periodic limb movements of sleep (PLMS) play a role in nocturnal hypertension and increased cardiovascular risk of renally impaired patients? Chronobiol Int 2009;26:1206-1221.
- Lin CH, Sy HN, Chang HW, Liou HH, Lin CY, Wu VC, Wu SL, Chang CC, Chiu PF, Li WY, Lin SY, Wu KD, Chen YM, Wu RM: Restless legs syndrome is associated with cardio/cerebrovascular events and mortality in end-stage renal disease. Eur J Neurol 2015;22:142-149.
- Molnar MZ, Szentkiralyi A, Lindner A, Czira ME, Szeifert L, Kovacs AZ, Fornadi K, Szabo A, Rosivall L, Mucsi I, Novak M: Restless legs syndrome and mortality in kidney transplant recipients. Am J Kidney Dis 2007;50:813-820.
- Stefanidis I, Vainas A, Giannaki CD, Dardiotis E, Spanoulis A, Sounidaki M, Eleftheriadis T, Liakopoulos V, Karatzaferi C, Sakkas GK, Zintzaras E, Hadjigeorgiou GM: Restless legs syndrome does not affect 3-year mortality in hemodialysis patients. Sleep Med 2015;16:1131-1138.
- Santos RS, Moyses RM, Elias RM: Impact of restless leg syndrome on mortality in patients on hemodialysis: still debatable. Sleep Med 2016;22:102.
- Stefanidis I, Vainas A, Giannaki CD, Dardiotis E, Spanoulis A, Sounidaki M, Eleftheriadis T, Liakopoulos V, Karatzaferi C, Sakkas GK, Zintzaras E, Hadjigeorgiou GM: Restless legs syndrome and mortality in hemodialysis patients. Sleep Med 2016;22:103.
- World Medical Association: World Medical Association Declaration of Helsinki: ethical principles for medical research involving human subjects. JAMA 2013;310:2191-2194.
- Walters AS: Toward a better definition of the restless legs syndrome. The International Restless Legs Syndrome Study Group. Mov Disord 1995;10:634-642.
- Walters AS, LeBrocq C, Dhar A, Hening W, Rosen R, Allen RP, Trenkwalder C; International Restless Legs Syndrome Study Group: Validation of the International Restless Legs Syndrome Study Group rating scale for restless legs syndrome. Sleep Med 2003;4:121-132.
- Enomoto M, Inoue Y, Namba K, Munezawa T, Matsuura M: Clinical characteristics of restless legs syndrome in end-stage renal failure and idiopathic RLS patients. Mov Disord 2008;23:811-816.
- 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.
- Shastri S, Sarnak MJ: Cardiovascular disease and CKD: core curriculum 2010. Am J Kidney Dis 2010;56:399-417.
- van der Zee S, Baber U, Elmariah S, Winston J, Fuster V: Cardiovascular risk factors in patients with chronic kidney disease. Nat Rev Cardiol 2009;6:580-589.
Foley RN, Parfrey PS, Sarnak MJ: Clinical epidemiology of cardiovascular disease in chronic renal disease. Am J Kidney Dis 1998;32(5 suppl 3):S112-S119.
- Go AS, Chertow GM, Fan D, McCulloch CE, Hsu CY: Chronic kidney disease and the risks of death, cardiovascular events, and hospitalization. N Engl J Med 2004;351:1296-1305.
- Stefanidis I, Vainas A, Dardiotis E, Giannaki CD, Gourli P, Papadopoulou D, Vakianis P, Patsidis E, Eleftheriadis T, Liakopoulos V, Pournaras S, Sakkas GK, Zintzaras E, Hadjigeorgiou GM: Restless legs syndrome in hemodialysis patients: an epidemiologic survey in Greece. Sleep Med 2013;14:1381-1386.
- Gopaluni S, Sherif M, Ahmadouk NA: Interventions for chronic kidney disease-associated restless legs syndrome. Cochrane Database Syst Rev 2016;11:CD010690.
Article / Publication Details
Copyright / Drug Dosage / DisclaimerCopyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.