[Restless legs syndrome in kidney patients]. / Anxietas Tibiarum: restless legs syndrome non sempre il movimento è salute nel paziente uremico.

Restless legs syndrome (RLS) is a sensorimotor disorder characterized by a strong urge to move the legs associated with paresthesias, motor restlessness, worsening of symptoms at night, and at least partial relief by activity. RLS has a negative impact on sleep, may cause depressive and anxious states, result in poor quality of life, and be a risk factor for cardiovascular disease. RLS is frequent in patients with end-stage renal disease; in this patient population it is consistently associated with severe comorbidities. It remains an underdiagnosed clinical condition. Appropriate diagnosis and management of RLS and sleep disorders is necessary to improve the quality of life and survival of kidney patients.

Outcomes of surgical revision of stenosed and thrombosed forearm arteriovenous fistulae for haemodialysis.

BACKGROUND: Surgery is an established treatment for stenosed and thrombosed forearm arteriovenous fistulae (AVFs), but the literature on its outcome is limited. We report our experience of the surgical repair of stenosis in patent and thrombosed forearm AVFs and evaluate the outcome of two procedures, proximal neo-anastomosis (NEO) vs replacement of the stenosed segment with a polytetrafluoroethylene graft interposition (GI). METHODS: Sixty-four stenosed forearm AVFs underwent surgery, 32 pre-emptively and 32 post-thrombosis. End points of the study were initial success, restenosis and access loss rates. After treatment, AVFs were surveilled for restenosis by measuring access flow quarterly and performing at least one follow-up angiogram. RESULTS: Initial procedural success was 92%; 100% for patent and 84% for thrombosed AVFs. The restenosis rate was 0.189 events/AVF-year for both patent and thrombosed AVFs, while the access loss rate was 0.016 events/AVF-year in patent and 0.148 in thrombosed AVFs. Stenosis was corrected by NEO in 27 AVFs and by GI in 30. The restenosis and access loss rates were 0.151 vs 0.214 and 0.033 vs 0.019 events/AVF-year for NEO vs GI, respectively. At Cox's hazard analysis, no variable was significantly associated with restenosis, while the timing of intervention was the only significant determinant of access loss, repaired clotted accesses carrying an 8.0-fold relative risk of access loss compared with patent AVFs (P=0.048). CONCLUSION: Our study shows that surgery remains a valid option for the pre-emptive repair of stenosis and to salvage clotted forearm AVFs, offering an excellent initial success rate and low restenosis rate. It confirms that it is better to treat stenosis pre-emptively than post-thrombosis (though the restenosis rate appears to be uninfluenced by the timing of intervention) and suggests that GI compares favourably with conventional NEO.

Practice patterns in the management of arteriovenous fistula stenosis: a northern Italian survey.

BACKGROUND: Clinical practice for stenosis detection and treatment in arteriovenous fistulas (AVFs) varies widely and is largely dictated by local customs and expertise. METHODS: In May 2003, a questionnaire was sent to 32 hemodialysis (HD) facilities in north-eastern Italy, to assess the prevalence of patients with an AVF; the screening criteria for stenosis; the preferred imaging technique; the timing of the intervention and the treatment modality for stenosed and thrombosed AVFs. RESULTS: The response rate was 87%; 2895 prevalent patients were evaluated, 86% with an AVF. All facilities routinely screened for stenosis; the majority relying on clinical assessment (86%), and many on multiple surveillance methods by monitoring dialysis pressures and blood pump flow rate (75-68%), measuring access recirculation (64%), Kt/V (54%) and access blood flow rate (11%). Angiography and Doppler ultrasound were used in equal proportion for imaging. All nephrologists agreed on pre-emptive stenosis correction, 57% taking action on well functioning and 43% on failing AVFs. Forty percent of nephrologists preferred either angioplasty or surgery for pre-emptive stenosis correction, while only 18% used both. Surgery was favored over endovascular techniques (57 vs. 36%) for treating thrombosed AVFs, while only 7% of facilities used both. CONCLUSIONS: Our survey shows that, as in 2003, the vast majority of patients in north-eastern Italy were dialyzed with an AVF. Screening for stenosis was universally adopted, though most facilities relied on clinical examination and surrogate access blood flow rate markers. All nephrologists agreed to pre-emptive stenosis correction, and surgery retained a relevant role in the treatment of stenosed and thrombosed AVFs.