Restless legs syndrome in end-stage renal disease: a multicenter study in Taiwan

Restless legs syndrome (RLS) is an underestimated movement disorder in patients with end-stage renal disease (ESRD). Several clinical and laboratory factors were inconsistently reported to associate with RLS. We aim to perform a large-scale multicenter study to investigate the possible associated risk factors of RLS in patients with ESRD in Taiwan, a country with the highest incidence of uremia in the world.

From October 2009 to October 2011, we constitutively recruited 1130 patients with ESRD from 17 hemodialysis centers. Demographic, laboratory data, presence and severity of RLS were collected. Odds ratios (ORs) were estimated by logistic regression models.

We found the prevalence of RLS to be 25.3% in patients with ESRD. Having type 2 diabetes [OR = 3.61 (2.27-5.77), P < 0.01], low serum transferrin saturation [OR = 1.42 (1.01-2.03), P < 0.05] and duration of dialysis [OR = 1.09 (1.03-1.14), P < 0.01] were associated with RLS. In contrast, high serum hemoglobin level was inversely associated with RLS [OR = 0.61 (0.40-0.89), P < 0.05]. RLS has a significant impact on sleep quality in dialysis patients. Among patients with RLS, history of type 2 diabetes [OR = 4.04 (1.65-10.79), P < 0.05], low serum hemoglobin level [OR = 5.41 (2.43-13.12), P < 0.01] and duration of dialysis [OR = 1.01 (1.01-1.02), P < 0.01] were associated with increased severity of RLS.

Our findings demonstrated that RLS is common in Taiwanese dialysis patients. Clinicians should have a high suspicion for the presence of RLS symptoms in patients with ESRD, especially those with type 2 diabetes, anemia, low serum iron status and long duration of dialysis.