Medications associated with restless legs syndrome: a case–control study in the US Renal Data System (USRDS)

Abstract

Objective To determine the association between the usage of four classes of “at risk” medications (antidepressants, neuroleptics, antihistamines, and anti-emetics with dopamine blockade) and restless legs syndrome (RLS) in dialysis patients within the United States Renal Data System (USRDS). Methods This was a case-control design within a national (United States) patient registry of all patients with End Stage Renal Disease (ESRD) in the USRDS anytime during the period of October 1, 2006 and December 31, 2010, inclusive. A total of 16,165 ESRD patients (3,234 Cases; 12,931 age-, sex-, and race-matched Controls) were studied. Results All four classes of “at risk” medications see widespread use among patients in the USRDS. All were associated with increased odds of a RLS diagnosis (range of Odds Ratios: 1.47 to 2.28, all p < .0001) during the period of observation. Results were unchanged when controlling for time on hemodialysis. Usage of more than one class of medication increased the odds for having RLS. Conclusions ESRD patients often receive medication intended for relief of conditions associated with their disease, such as depression and psychological issues, pruritis and gastroparesis, however such medications may increase risk for RLS. Given the high prevalence of RLS in ESRD patients, these medications should only be used when their benefits clearly outweigh the risk of development of the troubling and distressing symptoms of restless legs syndrome.

Association of restless legs syndrome and mortality in end-stage renal disease: an analysis of the United States Renal Data System (USRDS)

“…Patient survival was calculated as the time (in months) from dialysis initiation until transplant, death, or end of study data. Additionally, patients that had been diagnosed with Parkinson’s disease or secondary parkinsonism were excluded to reduce the likelihood of misdiagnosis of RLS due to pre-existing movement disorders [ 27 ]. The comorbidities of interest were identified using ICD-9-CM codes (Additional file 1 : Table S1).…”

Restless Legs Syndrome Caused by Quetiapine

“…Quetiapine has been found to display a high affinity for the H1 receptor, and several reports have described exacerbation of RLS symptoms on administration of antihistaminic medication [9]. In addition, some investigators have reported that administration of antihistamines, antidepressants, antipsychotics, and antiemetics may increase the risk of RLS in patients with end stage renal disease [10]. However, at the same time, a recent study has revealed the possible involvement of a striatal histamine mechanism in the pathogenesis of iron-deficiency anemia-induced RLS, and that histamine H3R antagonism may be efficacious in its management [11].…”

Neurological consults on the renal unit

“…Dopamine-blocking medications frequently used in end-stage kidney disease, such as antidepressants, neuroleptics, antihistamines and antiemetics, are each associated with doubling of the rate for restless legs syndrome 25. Restless legs syndrome is associated with impaired health-related quality of life, depression and increased mortality among patients with end-stage renal disease 26. Key aspects of management are correction of iron deficiency anaemia and regular exercise.…”