Restless legs syndrome does not affect 3-year mortality in hemodialysis patients.

OBJECTIVE: Uremic restless legs syndrome (RLS) has been related to an enhanced mortality of hemodialysis (HD) patients. In the general population studies of this association have yielded inconsistent results. The aim of the present study was to re-evaluate the relationship of RLS and mortality in HD patients. METHODS: We recorded the 3-year mortality in 579 HD patients after assessment for RLS symptoms. This population has been previously evaluated for the prevalence of RLS, according to the essential criteria of the International RLS Study Group. Mortality data were acquired from the national end-stage renal disease registry. Survival probability was calculated by the Kaplan-Meier method and analyzed by the log-rank test. For multivariate survival analysis, we implemented a Cox regression model. RESULTS: During the 3-year follow-up, we documented 118 deaths. Mortality was 15.6% in patients with RLS and 22.3% in patients without RLS (p = 0.079). According to the Cox regression analysis, there was no significant association between RLS and 3-year mortality, either in an age- and gender-adjusted model (hazard ratio [HR] = 0.772, 95% confidence interval [CI] = 0.488-1.219, p = 0.267) or in a multivariate adjusted model (HR = 0.667, 95% CI = 0.417-1.069, p = 0.092). CONCLUSION: Diagnosis of RLS according to the essential criteria of the International RLS Study Group does not seem to influence the 3-year mortality in HD patients. Our findings are in contrast to those in some previous reports, and reinforce the need for further studies of RLS and mortality in HD.

Restless legs syndrome in hemodialysis patients: an epidemiologic survey in Greece.

BACKGROUND: Restless legs syndrome (RLS) is a sensorimotor disorder characterized by an uncontrolled need to move extremities accompanied by unpleasant sensations, which frequently leads to sleep disturbances. In hemodialysis (HD) patients, the previously reported RLS prevalence varied enormously, between 6% and 60%. In our study, we investigated the RLS prevalence in HD patients for the first time in Greece. METHODS: A continuous sample of HD patients was studied between January and September of 2010 in six dialysis units in Greece. RLS diagnosis was based on the essential clinical criteria of the International RLS Study Group (IRLSSG). The standardized incidence ratio (SIR) for RLS in HD patients was calculated in comparison to data from a recent survey of the general population in Greece. RESULTS: In our study of 579 HD patients in Greece (236 women; mean age, 65±13years), the prevalence of RLS was elevated in comparison to the general population (26.6% vs 3.9%), with an SIR of 5.4 (95% confidence interval [CI], 4.6-6.3). In the fully adjusted model, the risk for RLS in HD patients was reduced in older age (odds ratio [OR], 0.98 [95% CI, 0.96-0.99]) and increased in women (OR, 1.60 [95% CI, 1.05-2.43]) in cases with elevated levels of ß2 microglobulin (OR, 1.15 [95% CI, 1.01-1.32]) and intact parathormone (iPTH) (OR, 1.30 [95% CI, 1.08-1.56]). CONCLUSION: A high RLS prevalence was recorded in a large HD population in Greece, clearly suggesting the need for enhanced awareness of RLS in nephrology. The RLS risk was increased in women and in younger HD patients as well as in those with elevated ß2 microglobulin and iPTH levels.