Background: Restless legs syndrome (RLS) is a movement disorder that affects 6.6–62% of dialysis patients. The aims of this multicentre cross-sectional study were to document the frequency, prevalence and severity of RLS in patients attending 5 dialysis centres for chronic hospital haemodialysis (HHD) and to identify associated risk factors. Methods: Thediagnosis of RLS was made using the criteria of The International Restless Legs Study Group. The following data were collected: age; gender; duration of renal replacement therapy (RRT); current smoking status; urea reduction ratio; weekly erythropoietin dose; weekly intravenous iron dose; prescribed beta blocker; prescribed renin/angiotensin system inhibitors and pre-dialysis blood concentrations of haemoglobin, ferritin, total calcium (corrected for albumin), albumin, phosphate, parathyroid hormone. Associations with RLS were analysed by univariate and multivariate logistic regression. Results: Data relating to 277 of 295 patients who had been attending for regular HHD for >3 months were collected. RLS was present in 127 (45.8%). 82 (29.6%), 27 (9.7%) and 18 (6.5%) patients had mild, moderate and severe RLS, respectively. 39 patients (14.1%) were prescribed medicines aimed at reducing RLS. 30 (76.9%) of these 39 patients still had RLS. Female gender (RR 2.17; p = 0.01), increasing duration since first dialysis (RR 1.06 per year; p = 0.03) and increasing body weight(RR 1.02 per kg; p = 0.02) were independent risk factors for RLS by multivariate analysis. In contrast to previous studies, we found no association with iron status, haemoglobin, serum phosphate or smoking. Conclusions: There is a high prevalence of RLS in our population and therapeutic intervention appears to have limited efficacy. The associations with female gender, duration of RRT and body weight deserve further study.

1.
Kavanagh D, Siddiqui S, Geddes CC: Restless legs syndrome in patients on dialysis. Am J Kidney Dis 2004;43:763–771.
2.
Allen RP, Earley CJ: Restless legs syndrome: a review of clinical and pathophysiologic features. J Clin Neurophysiol 2001;18:128–147.
3.
O’Keeffe ST: Restless legs syndrome: a review. Arch Intern Med 1996;156:243–248.
4.
Winkelman JW, Chertow GM, Lazarus JM: Restless legs syndrome in end-stage renal disease. Am J Kidney Dis 1996;28:372–378.
5.
Unruh ML, Levey AS, D’Ambrosio C, Fink NE, Powe NR, Meyer KB: Restless legs symptoms among incident dialysis patients: association with lower quality of life and shorter survival. Am J Kidney Dis 2004;43:900–909.
6.
Akpinar S: Treatment of restless legs syndrome with levodopa plus benserazide. Arch Neurol 1982;39:739.
7.
Montplaisir J, Godbout R, Poirier G, Bedard MA: Restless legs syndrome and periodic movements in sleep: physiopathology and treatment with L-dopa. Clin Neuropharmacol 1986;9:456–463.
8.
Winkelmann J, Schadrack J, Wetter TC, Zieglgansberger W, Trenkwalder C: Opioid and dopamine antagonist drug challenges in untreated restless legs syndrome patients. Sleep Med 2001;2:57–61.
9.
Walters AS: Toward a better definition of the restless legs syndrome. The International Restless Legs Syndrome Study Group. Mov Disord 1995;10:634–642.
10.
Sevim S, Dogu O, Camdeviren H, Bugdayci R, Sasmaz T, Kaleagasi H, Aral M, Helvaci I: Unexpectedly low prevalence and unusual characteristics of RLS in Mersin, Turkey. Neurology 2003;61:1562–1569.
11.
Berger K, Luedemann J, Trenkwalder C, John U, Kessler C: Sex and the risk of restless legs syndrome in the general population. Arch Intern Med 2004;164:196–202.
12.
Rothdach AJ, Trenkwalder C, Haberstock J, Keil U, Berger K: Prevalence and risk factors of RLS in an elderly population: the MEMO study. Memory and Morbidity in Augsburg Elderly. Neurology 2000;54:1064–1068.
13.
Lavigne GJ, Montplaisir JY: Restless legs syndrome and sleep bruxism: prevalence and association among Canadians. Sleep 1994;17:739–743.
14.
Ohayon MM, Roth T: Prevalence of restless legs syndrome and periodic limb movement disorder in the general population. J Psychosom Res 2002;53:547–554.
15.
Mortola JF, Laughlin GA, Yen SS: A circadian rhythm of serum follicle-stimulating hormone in women. J Clin Endocrinol Metab 1992;75:861–864.
16.
Nicolau GY, Haus E, Lakatua DJ, Bogdan C, Sackett-Lundeen L, Popescu M, Berg H, Petrescu E, Robu E: Circadian and circannual variations of FSH, LH, testosterone, dehydroepiandrosterone-sulfate (DHEA-S) and 17-hydroxy progesterone (17 OH-Prog) in elderly men and women. Endocrinologie 1985;23:223–246.
17.
Gigli GL, Adorati M, Dolso P, Piani A, Valente M, Brotini S, Budai R: Restless legs syndrome in end-stage renal disease. Sleep Med 2004;5:309–315.
18.
Roger SD, Harris DC, Stewart JH: Possible relation between restless legs and anaemia in renal dialysis patients. Lancet 1991;337:1551.
19.
Collado-Seidel V, Kohnen R, Samtleben W, Hillebrand GF, Oertel WH, Trenkwalder C: Clinical and biochemical findings in uremic patients with and without restless legs syndrome. Am J Kidney Dis 1998;31:324–328.
20.
Miranda M, Araya F, Castillo JL, Duran C, Gonzalez F, Aris L: Restless legs syndrome: a clinical study in adult general population and in uremic patients. Rev Med Chil 2001;129:179–186.
21.
Takaki J, Nishi T, Nangaku M, Shimoyama H, Inada T, Matsuyama N, Kumano H, Kuboki T: Clinical and psychological aspects of restless legs syndrome in uremic patients on hemodialysis. Am J Kidney Dis 2003;41:833–839.
22.
Phillips B, Young T, Finn L, Asher K, Hening WA, Purvis C: Epidemiology of restless legs symptoms in adults. Arch Intern Med 2000;160:2137–2141.
23.
Mucsi I, Molnar MZ, Rethelyi J, Vamos E, Csepanyi G, Tompa G, Barotfi S, Marton A, Novak M: Sleep disorders and illness intrusiveness in patients on chronic dialysis. Nephrol Dial Transplant 2004;19:1815–1822.
24.
Matthews WB: Letter: Iron deficiency and restless legs. Br Med J 1976;i:898.
25.
O’Keeffe ST, Gavin K, Lavan JN: Iron status and restless legs syndrome in the elderly. Age Ageing 1994;23:200–203.
26.
Sun ER, Chen CA, Ho G, Earley CJ, Allen RP: Iron and the restless legs syndrome. Sleep 1998;21:371–377.
27.
Benz RL, Pressman MR, Hovick ET, Peterson DD: A preliminary study of the effects of correction of anemia with recombinant human erythropoietin therapy on sleep, sleep disorders, and daytime sleepiness in hemodialysis patients (The SLEEPO study). Am J Kidney Dis 1999;34:1089–1095.
28.
Molnar MZ, Novak M, Ambrus C, Szeifert L, Kovacs A, Pap J, Remport A, Mucsi I: Restless Legs Syndrome in patients after renal transplantation. Am J Kidney Dis 2005;45:388–396.
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