Survival of Dialysis Patients with Restless Legs Syndrome: A 15-Year Follow-Up Study

Abstract

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.

Uremic Restless Legs Syndrome Pleads “Not Guilty”

“…Similarly, the mortality rate was not influenced by gender ( p = 0.15) and even more importantly by RLS severity ( p = 0.11). In addition, the study by Baiardi et al [7] revealed no difference among the causes of death between the 2 groups; this is in contrast to previous studies linking RLS to cardiovascular diseases [5] . The studies by Stefanidis et al [6] and Baiardi et al [7] clearly suggest that mortality in HD patients is not influenced by the presence of RLS/WED, as they provide no clinical evidence linking uremic RLS/ WED to cardiovascular mortality.…”

“…In addition, the study by Baiardi et al [7] revealed no difference among the causes of death between the 2 groups; this is in contrast to previous studies linking RLS to cardiovascular diseases [5] . The studies by Stefanidis et al [6] and Baiardi et al [7] clearly suggest that mortality in HD patients is not influenced by the presence of RLS/WED, as they provide no clinical evidence linking uremic RLS/ WED to cardiovascular mortality.Considering the discordant literature on the mortality risk in uremic RLS patients and the fact that cardiovascular disease is the number one cause of death in HD patients, the recent evidence by Baiardi et al [7] provides important data that will inform the design of the next prospective Disorders of the brain are becoming more prevalent and are both threatening quality of life as well as creating major challenges for the national health systems. Restless legs syndrome (RLS; or Willis/Ekbom disease) is one of the most common neurological disorders associated with significant personal, social and economic burden.…”

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there was no significant association between RLS and 3-year mortality, either with age and gender as covariates [6] .In the current issue of the American Journal of Nephrology , an unprecedented 15-year follow-up of RLS survivorship is presented by Baiardi et al [7] . These investigators demonstrate that RLS-HD patients had a lower mortality rate compared to those HD patients without the syndrome (63.8% [4.3%/year] RLS-HD vs. 87.6% [5.8%/year] non-RLS HD, p = 0.04).

…”

“…Considering the discordant literature on the mortality risk in uremic RLS patients and the fact that cardiovascular disease is the number one cause of death in HD patients, the recent evidence by Baiardi et al [7] provides important data that will inform the design of the next prospective Disorders of the brain are becoming more prevalent and are both threatening quality of life as well as creating major challenges for the national health systems. Restless legs syndrome (RLS; or Willis/Ekbom disease) is one of the most common neurological disorders associated with significant personal, social and economic burden.…”

Briefly Noted

“…A 15‐year follow‐up of 128 HD patients found that the 47 subjects with restless legs syndrome did not have a subsequent increase in their mortality rate …”