Restless legs symptoms among incident dialysis patients: Association with lower quality of life and shorter survival

doi:10.1053/j.ajkd.2004.01.013

American Journal of Kidney Diseases

Volume 43, Issue 5, May 2004, Pages 900-909

https://doi.org/10.1053/j.ajkd.2004.01.013 Get rights and content

Abstract

Background: Symptoms of restless legs are common among patients treated with long-term hemodialysis. We investigated the relation between symptoms of restless legs, quality of life, and survival among incident hemodialysis and peritoneal dialysis patients. Methods: This report includes 894 dialysis patients who responded to an item regarding severity of restless legs symptoms in the Choices for Healthy Outcomes in Caring for End-Stage Renal Disease Study. We examined participant responses both as categorized by the 5-point symptoms of restless legs item and classified with severe symptoms of restless legs if they reported they were very or extremely bothered by symptoms. Independent predictors of restless legs symptoms were estimated using logistic regression. The association of restless legs symptoms with quality of life was examined by means of mixed-model regression, and adjusted mortality risk was estimated by means of Cox proportional hazards. Results: Fifteen percent of dialysis patients were classified as having severe restless legs. Those characterized by severe restless legs were significantly more likely to be administered benzodiazepines, antidepressants, and antiepileptics. Age and diabetes mellitus were independently associated with severe symptoms of restless legs. Symptoms of restless legs were associated with lower Physical and Mental Component Scores, vitality, bodily pain, and sleep quality (all P < 0.001). After adjustment, severe symptoms of restless legs were significantly associated with an increased mortality hazard ratio of 1.39 (95% confidence interval, 1.08 to 1.79). Conclusion: Symptoms of restless legs were associated with lower quality of life and increased risk for death. The effect of treatment for symptoms of restless legs on quality of life and survival awaits additional study.

Section snippets

Study design and population

Study subjects were a subpopulation of patients participating in the CHOICE Cohort Study.12 CHOICE is a national prospective cohort study of incident hemodialysis and peritoneal dialysis patients initiated in 1995. From October 1995 to June 1998, a total of 1,041 patients (764 hemodialysis and 277 peritoneal dialysis patients) were enrolled from 80 dialysis clinics associated with Dialysis Clinic, Inc (Nashville, TN), New Haven CAPD (New Haven, CT), and the Hospital of St Raphael (New Haven,

Results

The CHOICE Cohort Study included 1,041 individuals. Patients were enrolled a median of 45 days from initiation of long-term dialysis therapy. Of these, 928 patients completed the CHEQ. Of patients who responded to the CHEQ, 894 patients (96.3%) completed the item about restless legs and comprised the sample of the present report. The 894 patients included in this study were more likely than the remaining 147 CHOICE patients to have white race (68.5% versus 57.5%; P = 0.03), more education

Discussion

In this study, 15% of patients beginning dialysis treatment for kidney failure reported severe symptoms of restless legs. The prevalence of these symptoms among peritoneal dialysis patients was similar to that among hemodialysis patients, and prevalence of symptoms did not vary by race of the respondent. Furthermore, severe restless legs symptoms were associated with substantially diminished physical functioning and mental well-being. Last, severe restless legs symptoms were independently

Acknowledgements

The authors thank the patients, staff, and physicians who participated in the CHOICE Study at Dialysis Clinic Inc, St Raphael's Hospital, and New Haven CAPD.

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: Supported in part by grant no. R01-HS-08365 from the Agency for Healthcare Research and Quality from June 1995 to May 2000 (CHOICE Study); grants no. R01-HL-62985, R01-DK-07024 (CHOICE Study), and K24-DK-02643 (N.R.P.) from the National Institute of Diabetes and Digestive and Kidney Diseases; and an American Society of Nephrology-Association for Subspecialty Professors Junior Development Grant in Geriatric Nephrology (M.L.U.).

View full text

Original investigation: dialysis therapyRestless legs symptoms among incident dialysis patients: Association with lower quality of life and shorter survival

Abstract

Section snippets

Study design and population

Results

Discussion

Acknowledgements

Am J Kidney Dis

Am J Kidney Dis

Am J Kidney Dis

Am J Kidney Dis

Am J Kidney Dis

Sleep Med Rev

Clin Ther

Kidney Int

Am J Kidney Dis

Am J Kidney Dis

Am J Kidney Dis

Physiol Behav

Am J Kidney Dis

Chest

Chest

Sleep Med

Am J Kidney Dis

Characterizing sleep disorders in chronic hemodialysis patients

ASAIO Trans

Practice parameters for the treatment of restless legs syndrome and periodic limb movement disorder. An American Academy of Sleep Medicine Report. Standards of Practice Committee of the American Academy of Sleep Medicine

Sleep

Toward a better definition of the restless legs syndrome. The International Restless Legs Syndrome Study Group

Mov Disord

Epidemiology of restless legs symptoms in adults

Arch Intern Med

An FDOPA PET study in patients with periodic limb movement disorder and restless legs syndrome

Neurology

Choices for Health Outcomes in Caring for End-Stage Renal Disease

Semin Dial

Original investigation: dialysis therapy
Restless legs symptoms among incident dialysis patients: Association with lower quality of life and shorter survival