Clinical management of restless legs syndrome in end-stage renal disease patients

The Effect of Superficial Heat-Cold Application on the Sleep Quality of Patients With Restless Leg Syndrome: A Systematic Review and Meta-Analysis

AIM

The present study was conducted to determine the effect of the superficial heat-cold application on the sleep quality of patients with restless leg syndrome.

DESIGN

This study was a systematic review and meta-analysis.

METHODS

In the present study, the electronic databases Scopus, ProQuest, Web of Science, PubMed, SID and Google Scholar were searched from their inception to September 2023. The quality of included studies was evaluated through the Cochrane Collaboration's Risk of Bias Tool, and finally, a meta-analysis was conducted by calculating standardised mean differences (SMDs).

RESULTS

The meta-analysis results revealed that superficial heat-cold application improved sleep quality in patients with RLS (SMD = 0.685, 95% CI: 0.421-0.950). The meta-regression results showed that as the temperature increased, the intervention was more effective in improving sleep quality (β = 0.0182, 95% CI: 0.0096-0.0268, p < 0.05). Moreover, the effectiveness of the intervention in improving the sleep quality of patients with RLS reduced significantly as the duration of intervention in each session (β = -0.031, 95% CI: -0.059 to -0.001, p < 0.05) as well as participants' age increased (β = -0.013, 95% CI: -0.024 to -0.001, p = 0.0259).

PATIENT OR PUBLIC CONTRIBUTION

This research showed that superficial heat-cold application had the capability to improve the sleep quality of patients with restless leg syndrome. In addition, in this study, settings were suggested according to which the maximum effectiveness of the intervention could be achieved.

Mechanisms underlying acupuncture therapy in chronic kidney disease: A narrative overview of preclinical studies and clinical trials

Chronic kidney disease (CKD) is associated with high incidence, low awareness, and high disability rates among the population. Moreover, the disease significantly affects the physical and mental health of patients. Approximately 25% of patients with CKD develop end-stage renal disease (ESRD) within 20 years of diagnosis and have to rely on renal replacement therapy, which is associated with high mortality, heavy economic burden, and symptoms including fatigue, pain, insomnia, uremia pruritus, and restless leg syndrome. Currently, the means to delay the progress of CKD are insufficient; therefore, developing strategies for delaying CKD progression has important practical implications. In recent years, more and more people are accepting the traditional Chinese medical technique "acupuncture." Acupuncture has been shown to improve the uncomfortable symptoms of various diseases through stimulation (needling, medicinal moxibustion, infrared radiation, and acupressure) of acupoints. Its application has been known for thousands of years, and its safety and efficacy have been verified. As a convenient and inexpensive complementary therapy for CKD, acupuncture has recently been gaining interest among clinicians and scientists. Nevertheless, although clinical trials and meta-analysis findings have demonstrated the efficacy of acupuncture in reducing albuminuria, improving glomerular filtration rate, relieving symptoms, and improving the quality of life of patients with CKD, the underlying mechanisms involved are still not completely understood. Few studies explored the correlation between acupuncture and renal pathological diagnosis. The aim of this study was to conduct a literature review summarizing the currently known mechanisms by which acupuncture could delay the progress of CKD and improve symptoms in patients with ESRD. This review help provide a theoretical basis for further research regarding the influence of acupuncture on renal pathology in patients with CKD, as well as the differences between specific therapeutic mechanisms of acupuncture in different renal pathological diagnosis. The evidence in this review indicates that acupuncture may produce marked effects on blocking and reversing the critical risk factors of CKD progression (e.g., hyperglycemia, hypertension, hyperlipidemia, obesity, aging, and anemia) to improve the survival of patients with CKD via mechanisms including oxidative stress inhibition, reducing inflammatory effects, improving hemodynamics, maintaining podocyte structure, and increasing energy metabolism.

A network meta-analysis of the effectiveness and safety of drugs for restless legs syndrome in dialysis patients

OBJECTIVE

To evaluate the efficacy and safety of nine pharmacological interventions for restless legs syndrome (RLS) in dialysis patients.

METHODS

An electronic database was used to retrieve eligible trials from PubMed, Cochrane, Embase, and Web of Science. Stata 14.2 software was used to perform network meta-analysis. The primary measure was the RLS score, and the secondary measure was used to evaluate the side effects of the drug. The surface under the cumulative ranking curve method was used to rank the merits of intervention measures. A comparison of the two interventions is shown on a league table.

RESULTS

Finally, nine randomized controlled trials (RCTs) with a total of 377 participants were included. From the results of the network meta-analysis, all treatments ranked higher than placebo in terms of improving clinical symptoms, but only vitamin C (standardized mean difference [SMD] = -1.47 95% confidence interval [CI] -2.89, -0.05) showed significant differences compared with placebo. In terms of safety, there were no serious adverse reactions to any of the treatments compared to placebo.

CONCLUSION

Currently, existing evidence suggests that vitamin C may be the most ideal drug to improve the symptoms of RLS in dialysis patients.

Images: Identification and Effect of Periodic Limb Movements in End-Stage Renal Disease

None

Sleep disorders are prevalent in patients with end-stage renal disease (ESRD). In those patients on nocturnal dialysis, it is important to perform objective sleep assessment during regular dialysis. We present the case of a man on continuous cycler peritoneal dialysis with disabling fatigue and moderate restless legs syndrome (RLS). Actigraphy demonstrated excessive nocturnal movement. Unattended home polysomnography, performed during his regular peritoneal dialysis, confirmed frequent nocturnal periodic limb movements with disturbed sleep. Treatment with low dose pramipexole led to improved RLS and marked improvement in his energy. Clinicians caring for patients with ESRD should have a low threshold for objective sleep assessment given that sleep disorders are common, disabling and eminently amenable to treatment.

Gabapentin and Pregabalin Use and Association with Adverse Outcomes among Hemodialysis Patients

Background Gabapentin and pregabalin are used to manage neuropathic pain, pruritus, and restless legs syndrome in patients on hemodialysis. These patients may be especially predisposed to complications related to these agents, which are renally cleared, but data regarding the risk thereof are lacking.Methods From the US Renal Data System, we identified 140,899 Medicare-covered adults receiving hemodialysis with Part D coverage in 2011. Using Cox regression models in which we adjusted for demographics, comorbidities, duration of exposure, number of medications, and use of potentially confounding concomitant medications, we investigated the association between gabapentin and pregabalin, modeled as separate time-varying exposures, and time to first emergency room visit or hospitalization for altered mental status, fall, and fracture. We evaluated risk according to daily dose categories: gabapentin (>0-100, >100-200, >200-300, and >300 mg) and pregabalin (>0-100 and >100 mg).Results In 2011, 19% and 4% of patients received gabapentin and pregabalin, respectively. Sixty-eight percent of gabapentin or pregabalin users had a diagnosis of neuropathic pain, pruritus, or restless legs syndrome. Gabapentin was associated with 50%, 55%, and 38% higher hazards of altered mental status, fall, and fracture, respectively, in the highest dose category, but even lower dosing was associated with a higher hazard of altered mental status (31%-41%) and fall (26%-30%). Pregabalin was associated with up to 51% and 68% higher hazards of altered mental status and fall, respectively.Conclusions Gabapentin and pregabalin should be used judiciously in patients on hemodialysis, and research to identify the most optimal dosing is warranted.

Effect of Near-Infrared Light Therapy Based on Acupoints on the Severity of Restless Legs Syndrome in Patients Undergoing Hemodialysis: A Single-Blind, Randomized Controlled Trial

INTRODUCTION

Restless legs syndrome (RLS) is a common disorder in hemodialysis patients. The present study was conducted to determine the effect of near-infrared (NIR) light therapy given to acupoints on the severity of RLS in patients undergoing hemodialysis.

METHODS

This single-blind, randomized controlled trial was performed on 60 hemodialysis patients with RLS. Participants who met the inclusion criteria were randomly assigned to an intervention group (n = 30) or a control group (n = 30). Data were collected using the International Restless Legs Syndrome Rating Scale (IRLSRS) and demographic information questionnaire. The intervention group received 12 sessions of NIR light therapy (940 nm) to acupoints in the legs and feet during hemodialysis three times a week, while the control group received sham treatment. Data were analyzed using SPSS version 22 software.

RESULTS

The results indicated that there were statistically and clinically significant differences between the intervention and control groups at the end of the intervention sessions (P < 0.001, mean difference [MD] = 3.8). However, after the treatment was discontinued, the difference was not clinically significant (MD = 2.4). In the within-group compression, the mean RLS scores of the intervention group decreased significantly during the intervention sessions (MD = 3.2, P < 0.001); however, after the treatment was discontinued, the difference was not clinically significant (MD = 1.67).

CONCLUSION

The present study showed that the application of NIR light to acupoints in the legs and feet was as an effective treatment for attenuating the symptoms of RLS in hemodialysis patients.