Epidemiology, impact, and treatment options of restless legs syndrome in end-stage renal disease patients: an evidence-based review

Abstract

Restless legs syndrome (RLS) (or Willis-Ekbom disease) is a neurological disorder with high prevalence among the end-stage renal disease population. This is one of the most predominant types of secondary RLS, and it is called uremic RLS. Despite the fact that uremic RLS has been less studied compared to idiopathic RLS, recent studies now shed light in many aspects of the syndrome including clinical characteristics, impact, epidemiology, and treatment options. The current review discusses the above topics with special emphasis given on the management of uremic RLS, including the management of symptoms that often appear during a hemodialysis session. Uremic RLS symptoms may be ameliorated by using pharmacological and nonpharmacological treatments. Evidence so far shows that both approaches may be effective in terms of reducing the RLS symptom's severity; nevertheless, more research is needed on the efficiency of treatments for uremic RLS.

Restless Leg Syndrome, Insomnia, and Depression in Hemodialysis Patients: Three Sides of a Triangle?

“…Several factors influence the severity of RLS such as hypertension, female gender, weight, dialysis shift, age, and diabetes in patients undergoing hemodialysis (1). The effects of dialysis modality and adequacy on the severity of RLS are controversial.…”

“…There is a strong relationship between insomnia and depression, as insomnia is a symptom of depression and also a risk factor to deteriorate depression (9). There are reports on the correlation between RLS and mental health, depression, decreased quality of life, and increased mortality among patient underwent transplantation or undergoing hemodialysis (1,(10)(11)(12)(13)(14). RLS is one of the most powerful causes of insomnia in chronic kidney diseases, however, sleep disorder cause depression (11,15,16).…”

“…Restless legs syndrome (RLS) is a sensory-motor neurologic disorder characterized by an uncomfortable sensation in legs along with obligatory leg movement to relief the complication (1).…”

Restless leg syndrome: Does various geographic area have any effect on its different prevalence?

“…[1] In addition, a review article noted the prevalence of "uremic RLS" was approximately 30% in endstage renal disease (ESRD) patients. [2] However, its prevalence in this group ranged between 6.6% and 80% in various reports. [3][4][5] Based on the International RLS Study Group (IRLSSG) criteria, an RLS prevalence of 33% has been reported in ESRD patients, which is greater than the normal population (3%-15%); [6,7] however, a study in Singapore showed lower prevalence in normal Asian population (0.1%-0.6%).…”

Restless Legs Syndrome: An Unresolved Uremic Disorder after Renal Transplantation

“…In addition, RLS may represent a novel risk factor contributing to renal and cardiovascular damage [6, 7]. The reported prevalence of RLS among ESRD is as high as 30–50%; however, most surveys are based on self-administered questionnaires, without objective measures like polysomnography or even expert examination [8-12]. While Merlino et al [13] reported a 10.9% prevalence of RLS in non-dialysis chronic kidney disease (CKD) after expert investigation, we documented a 4.5% prevalence of RLS in this group of patients, similar to the frequency reported for the general population [13, 14].…”