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Capelli I, Pizza F, Ruggeri M, Gasperoni L, Carretta E, Donati G, Cianciolo G, Plazzi G, La Manna G. Time evolution of restless legs syndrome in haemodialysis patients. Clin Kidney J 2019; 14:341-347. [PMID: 33564437 PMCID: PMC7857816 DOI: 10.1093/ckj/sfz148] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2019] [Accepted: 09/10/2019] [Indexed: 02/05/2023] Open
Abstract
Background Restless legs syndrome (RLS) is characterized by an urge to move the extremities, accompanied by paraesthesiae, in the evening and at night. Uraemic RLS, a type of secondary RLS, occurs commonly in chronic kidney disease and end-stage renal disease. Progression of uraemic RLS over time is unclear. Therefore we investigated the prevalence, progression over time, risk factors and impact on survival of uraemic RLS in a cohort of dialysis patients. Methods We reviewed at the 7-year follow-up a cohort of haemodialysis (HD) patients we had previously investigated for RLS, through interviews, validated questionnaires and analysis of demographic and clinical data. Results At the 7-year follow-up, RLS was present in 16% of patients, with a persistence rate of 33%. A correlation was obtained between RLS and older age, diabetes, low albumin and low body mass index. RLS was associated with reduced overall survival (median survival of 3.3 versus 3.7 years), particularly with the continuous form of RLS (1.61 years). There was a higher incidence of myocardial infarction and peripheral vascular disease, although not reaching statistical significance. RLS patients had absolute higher scores in all quality of life domains. A large majority of study patients (96%) reported being symptom-free within a few days or weeks following kidney transplantation. Conclusions The development of RLS, especially the continuous form, in patients undergoing HD has important consequences associated with decreased survival. Our results indicated an association between uraemic RLS and ageing, diabetes and malnutrition. Considerable efforts should be focused on the treatment of RLS, since it significantly and persistently impacts the quality of life of HD patients. Kidney transplantation could represent an effective treatment option for that RLS impacts on dialysis patients' quality of life, thus confirming the secondary nature of RLS in most HD patients.
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Affiliation(s)
- Irene Capelli
- Department of Experimental, Diagnostic and Specialty Medicine, Nephrology, Dialysis and Transplantation Unit, St Orsola Hospital, University of Bologna, Bologna, Italy
| | - Fabio Pizza
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum, University of Bologna, Bologna, Italy.,IRCSS, Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Marco Ruggeri
- Department of Experimental, Diagnostic and Specialty Medicine, Nephrology, Dialysis and Transplantation Unit, St Orsola Hospital, University of Bologna, Bologna, Italy
| | - Lorenzo Gasperoni
- Department of Experimental, Diagnostic and Specialty Medicine, Nephrology, Dialysis and Transplantation Unit, St Orsola Hospital, University of Bologna, Bologna, Italy
| | | | - Gabriele Donati
- Department of Experimental, Diagnostic and Specialty Medicine, Nephrology, Dialysis and Transplantation Unit, St Orsola Hospital, University of Bologna, Bologna, Italy
| | - Giuseppe Cianciolo
- Department of Experimental, Diagnostic and Specialty Medicine, Nephrology, Dialysis and Transplantation Unit, St Orsola Hospital, University of Bologna, Bologna, Italy
| | - Giuseppe Plazzi
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum, University of Bologna, Bologna, Italy.,IRCSS, Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Gaetano La Manna
- Department of Experimental, Diagnostic and Specialty Medicine, Nephrology, Dialysis and Transplantation Unit, St Orsola Hospital, University of Bologna, Bologna, Italy
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Parajuli S, Tiwari R, Clark DF, Mandelbrot DA, Djamali A, Casey K. Sleep disorders: Serious threats among kidney transplant recipients. Transplant Rev (Orlando) 2019; 33:9-16. [PMID: 30287137 DOI: 10.1016/j.trre.2018.09.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2018] [Revised: 09/17/2018] [Accepted: 09/21/2018] [Indexed: 12/19/2022]
Affiliation(s)
- Sandesh Parajuli
- Division of Nephrology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States.
| | - Rachna Tiwari
- Division of Sleep Medicine, William S. Middleton Memorial Veterans Hospital, Madison, WI, United States
| | - Dana F Clark
- Division of Nephrology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States
| | - Didier A Mandelbrot
- Division of Nephrology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States
| | - Arjang Djamali
- Division of Nephrology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States; Division of Transplant Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States
| | - Kenneth Casey
- Division of Sleep Medicine, William S. Middleton Memorial Veterans Hospital, Madison, WI, United States
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Aristotelous P, Aphamis G, Sakkas GK, Andreou E, Pantzaris M, Kyprianou T, Hadjigeorgiou GM, Manconi M, Giannaki CD. Effects of controlled dehydration on sleep quality and quantity: A polysomnographic study in healthy young adults. J Sleep Res 2018; 28:e12662. [DOI: 10.1111/jsr.12662] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Accepted: 12/20/2017] [Indexed: 11/29/2022]
Affiliation(s)
| | - George Aphamis
- Department of Life and Health Sciences University of Nicosia Nicosia Cyprus
| | - Giorgos K. Sakkas
- Faculty of Sport and Health Sciences University of St Mark & St John Plymouth UK
| | - Eleni Andreou
- Department of Life and Health Sciences University of Nicosia Nicosia Cyprus
| | | | - Theodoros Kyprianou
- Department of Life and Health Sciences University of Nicosia Nicosia Cyprus
- General Hospital of Nicosia Nicosia Cyprus
| | | | - Mauro Manconi
- Sleep and Epilepsy Center Neurocenter of Southern Switzerland Civic Hospital (EOC) of Lugano Lugano Switzerland
- Neurology Department Inselspital Bern University Hospital Bern Switzerland
| | - Christoforos D. Giannaki
- Department of Life and Health Sciences University of Nicosia Nicosia Cyprus
- The Cyprus Institute of Neurology and Genetics Nicosia Cyprus
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Giannaki CD, Hadjigeorgiou GM, Aphamis G, Pantzaris M, Sakkas GK. Restless legs syndrome in adolescents: relationship with sleep quality, cardiorespiratory fitness and body fat. ACTA ACUST UNITED AC 2017; 10:7-10. [PMID: 28966732 PMCID: PMC5611766 DOI: 10.5935/1984-0063.20170002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Objective The aim of the current study was to investigate the relationship between
restless legs syndrome (RLS) and cardiorespiratory fitness, body composition
and sleep quality in a sample of adolescents. Methods One hundred fifty seven volunteer adolescents (16.6 ± 0.7 yrs)
participated in the study. Sleep quality was assessed by the Pittsburg sleep
quality index. Cardiorespiratory fitness was assessed by the 20 m shuttle
run test and body composition by bioelectrical impedance analysis. Results The prevalence of RLS was 5.1%. The adolescents with RLS were found to
exhibit significantly higher body fat levels (p=0.019) and
poorer sleep quality score (p=0.000) compared with their
free-RLS counterparts. Conclusions Adolescents with RLS are subjects of higher body fat and impaired sleep
quality compared with adolescents without RLS. Early diagnosis and
appropriate management of RLS is essential in the adolescents.
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Affiliation(s)
- Christoforos D Giannaki
- Department of Life and Health Sciences, University of Nicosia, Nicosia, Cyprus.,The Cyprus Institute of Neurology and Genetics, Nicosia, Cyprus
| | | | - George Aphamis
- Department of Life and Health Sciences, University of Nicosia, Nicosia, Cyprus
| | | | - Giorgos K Sakkas
- Faculty of Sport and Health Sciences, University of St Mark & St John, Plymouth, UK
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The Effect of Cold Dialysis in Motor and Sensory Symptoms of RLS/WED Occurring During Hemodialysis: A Double-Blind Study. ASAIO J 2017; 64:110-114. [PMID: 28682991 DOI: 10.1097/mat.0000000000000622] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Restless legs syndrome/Willis-Ekbom disease (RLS/WED) is a common sensorimotory disorder affecting almost 30% of hemodialysis (HD) patients. RLS/WED induces discomfort during rest hours, and its symptoms have also been observed during HD sessions. Anecdotal reports suggest that cooling the dialysate solution during dialysis could help patients overcome those symptoms and improve restlessness. The aim of this double-blind study was to assess whether a reduction of the dialysate temperature by 1°C could reduce motor and sensory symptoms of RLS/WED occurring during HD. Thirty-two HD patients participated in the study. Patients were divided into two groups: the RLS (N=16) and the non-RLS groups (N=16). Patients were studied on two different scenarios for two consecutive HD sessions, 1 week apart: 1) standard temperature of the dialysate (37°C) and 2) low temperature of the dialysate (36°C cold dialysis scenario). In all sessions, motor (leg movement per hour of HD [LM/hHD]) and sensory symptoms were assessed. The reduction of dialysate temperature by 1°C was effective in reducing motor symptoms as they assessed the LM/hHD by 36% only in patients with RLS, while a significant interaction was found between "LM/hHD affected by temperature" and "RLS status" (p = 0.039). Sensory symptoms also reduced by 10% after the reduction of the dialysate temperature. The reduction of the dialysate temperature by 1°C reduced motor symptoms by 36-54% and sensory symptoms by 10% in HD patients with RLS/WED. Cold dialysis could be considered a safe nonpharmacological approach for the amelioration of RLS/WED symptoms occurring during HD.
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Giannaki CD, Hadjigeorgiou GM, Aphamis G, Pantzaris M, Sakkas GK. Restless legs syndrome in adolescents: Relationship with sleep quality, cardiorespiratory fitness and body fat. Sleep Sci 2017. [DOI: 10.1016/j.slsci.2017.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Current trends in the management of uremic restless legs syndrome: a systematic review on aspects related to quality of life, cardiovascular mortality and survival. Sleep Med Rev 2014; 21:39-49. [PMID: 25261116 DOI: 10.1016/j.smrv.2014.07.006] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2014] [Revised: 07/26/2014] [Accepted: 07/28/2014] [Indexed: 12/22/2022]
Abstract
Restless legs syndrome (RLS) affects almost one out of three end-stage renal disease patients. This review assesses the current treatment options for uremic RLS and the potential benefits of those treatments on quality of life parameters, cardiovascular mortality and survival. A systematic review was conducted searching PubMed and Scopus by using the Cochrane and PRISMA guidelines. Fourteen studies met the inclusion criteria in which the international RLS study group criteria were used as the primary diagnostic tool. Both pharmacological and non-pharmacological approaches were found to reduce the severity of uremic RLS symptoms. Only four studies reported changes on aspects related to quality of life while those changes were also associated with health benefits that resulted in reduced cardiovascular risk. The severity of uremic RLS symptoms can be ameliorated by using dopamine agonists and gabapentin, intravenous iron, exercise or supplementation with vitamins C and E, although some of those treatment benefits may be transient. There is a lack of strong evidence regarding the effects of the pharmacological approaches on quality of life and cardiovascular survival and mortality. In contrast exercise has been proven beneficial in both reducing the RLS symptoms' severity score and improving the quality of life.
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