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      Restless legs syndrome in chronic renal failure patients on dialysis

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          Abstract

          Background

          Restless legs syndrome (RLS) occurs in patients with chronic renal failure (CRF).

          Objectives

          To determine the prevalence and morbidity of RLS in CRF patients on dialysis.

          Methods

          This cross-sectional questionnaire-based study included 100 dialysis patients (50 on haemodialysis [HD]; 50 on peritoneal dialysis [PD]). A focused lower limb examination was done. Patients were classified with RLS when reporting uncomfortable feelings in their legs that improved with movement and worsened when resting and at night.

          Results

          Gender distribution was equal. The median age was 43 (19–67) years. Six patients (HD and PD n=3 each) had international criteria-confirmed RLS. Twenty-four patients reported symptoms suggestive of RLS. Fourteen and 16 patients with RLS symptoms were on HD and PD, respectively. Sleep disturbances occurred in 43.3% (n=13) of patients with RLS symptoms, compared to 20.0% (n=20) of the large cohort. Sleep disturbances, peripheral sensory loss, chronic disease-related anaemia, increased urea and decreased albumin levels were more common among patients with RLS symptoms.

          Conclusion

          RLS symptoms occurred in 30.0% of the entire cohort, although only 6.0% met the international criteria. The type of dialysis had no impact on the incidence of symptoms. Identifying RLS in patients with CRF on dialysis will allow for early intervention.

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          Restless legs syndrome associated with major diseases: A systematic review and new concept.

          Claudia Trenkwalder, Richard Allen, Birgit Högl … (2016)
          Recent publications on both the genetics and environmental factors of restless legs syndrome (RLS) defined as a clinical disorder suggest that overlapping genetic risk factors may play a role in primary (idiopathic) and secondary (symptomatic) RLS. Following a systematic literature search of RLS associated with comorbidities, we identified an increased prevalence of RLS only in iron deficiency and kidney disease. In cardiovascular disease, arterial hypertension, diabetes, migraine, and Parkinson disease, the methodology of studies was poor, but an association might be possible. There is insufficient evidence for conditions such as anemia (without iron deficiency), chronic obstructive pulmonary disease, multiple sclerosis, headache, stroke, narcolepsy, and ataxias. Based on possible gene-microenvironmental interaction, the classifications primary and secondary RLS may suggest an inappropriate causal relation. We recognize that in some conditions, treatment of the underlying disease should be achieved as far as possible to reduce or eliminate RLS symptoms. RLS might be seen as a continuous spectrum with a major genetic contribution at one end and a major environmental or comorbid disease contribution at the other.
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            Restless legs syndrome prevalence and impact: REST general population study.

            Jonathan Allen, Wayne Hening, Jordana Bell … (2005)
            Restless legs syndrome (RLS), a common sensorimotor disorder, has a wide range of severity from merely annoying to affecting sleep and quality of life severely enough to warrant medical treatment. Previous epidemiological studies, however, have failed to determine the prevalence of those with clinically significant RLS symptoms and to examine the life effects and medical experiences of this group. A total of 16 202 adults (aged >/=18 years) were interviewed using validated diagnostic questions to determine the presence, frequency, and severity of RLS symptoms; respondents reporting RLS symptoms were asked about medical diagnoses and the impact of the disorder and completed the Short Form-36 Health Survey (SF-36). Criteria determined by RLS experts for medically significant RLS (frequency at least twice a week, distress at least moderate) defined "RLS sufferers" as a group most likely to warrant medical treatment. In all, 15 391 fully completed questionnaires were obtained; in the past year, RLS symptoms of any frequency were reported by 1114 (7.2%). Symptoms occurred at least weekly for 773 respondents (5.0%); they occurred at least 2 times per week and were reported as moderately or severely distressing by 416 (2.7%). Of those 416 (termed RLS sufferers), 337 (81.0%) reported discussing their symptoms with a primary care physician, and only 21 (6.2%) were given a diagnosis of RLS. The SF-36 scores for RLS sufferers were significantly below population norms, matching those of patients with other chronic medical conditions. Clinically significant RLS is common (prevalence, 2.7%), is underdiagnosed, and significantly affects sleep and quality of life.
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              Neurological complications in chronic kidney disease

              Ria Arnold, Tushar Issar, Arun V. Krishnan … (2016)
              Patients with chronic kidney disease (CKD) are frequently afflicted with neurological complications. These complications can potentially affect both the central and peripheral nervous systems. Common neurological complications in CKD include stroke, cognitive dysfunction, encephalopathy, peripheral and autonomic neuropathies. These conditions have significant impact not only on patient morbidity but also on mortality risk through a variety of mechanisms. Understanding the pathophysiological mechanisms of these conditions can provide insights into effective management strategies for neurological complications. This review describes clinical management of neurological complications in CKD with reference to the contributing physiological and pathological derangements. Stroke, cognitive dysfunction and dementia share several pathological mechanisms that may contribute to vascular impairment and neurodegeneration. Cognitive dysfunction and dementia may be differentiated from encephalopathy which has similar contributing factors but presents in an acute and rapidly progressive manner and may be accompanied by tremor and asterixis. Recent evidence suggests that dietary potassium restriction may be a useful preventative measure for peripheral neuropathy. Management of painful neuropathic symptoms can be achieved by pharmacological means with careful dosing and side effect considerations for reduced renal function. Patients with autonomic neuropathy may respond to sildenafil for impotence. Neurological complications often become clinically apparent at end-stage disease, however early detection and management of these conditions in mild CKD may reduce their impact at later stages.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Afr Health Sci
                Journal ID (iso-abbrev): Afr Health Sci
                Title: African Health Sciences
                Publisher: Makerere Medical School (Kampala, Uganda )
                ISSN (Print): 1680-6905
                ISSN (Electronic): 1729-0503
                Publication date (Print): September 2023
                Volume: 23
                Issue: 3
                Pages: 764-777
                Affiliations
                [1 ] Department of Neurology, School of Clinical Medicine, Faculty of Health Sciences, University of the Free State, Bloemfontein, South Africa
                [2 ] Department of Biostatistics, School of Biomedical Sciences, Faculty of Health Sciences, University of the Free State, Bloemfontein, South Africa
                [3 ] Department of Neurology, School of Clinical Medicine, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
                Author notes
                Corresponding author Carin Behrens van Tonder, Department of Neurology, Faculty of Health Sciences, University of the Free State, 205 Nelson Mandela Drive, Bloemfontein 9300, South Africa Tel: +27 72 837 6243 carinbvantonder@ 123456gmail.com
                Article
                Publisher ID: jAFHS.v23.i3.pg764
                DOI: 10.4314/ahs.v23i3.88
                PMC ID: 10862641
                PubMed ID: 38357105
                SO-VID: 5eab0776-d046-41e0-8fae-21ef0bfca1b6
                Copyright © © 2023 van Tonder CB et al.
                License:

                Licensee African Health Sciences. This is an Open Access article distributed under the terms of the Creative commons Attribution License ( https://creativecommons.org/licenses/BY/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Categories
                Subject: Articles

                Keywords: restless legs syndrome,chronic renal failure,haemodialysis,peritoneal dialysis,symptoms
                Data availability:
                Keywords: restless legs syndrome, chronic renal failure, haemodialysis, peritoneal dialysis, symptoms

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