Restless legs syndrome is contributing to fatigue and low quality of life levels in hemodialysis patients

Christoforos D Giannaki, Michael Hadjigavriel, Akis Lazarou, Aristos Michael, Loukas Damianou, Efthimios Atmatzidis, Ioannis Stefanidis, Georgios M Hadjigeorgiou, Giorgos K Sakkas, Marios Pantzaris, Christoforos D Giannaki, Michael Hadjigavriel, Akis Lazarou, Aristos Michael, Loukas Damianou, Efthimios Atmatzidis, Ioannis Stefanidis, Georgios M Hadjigeorgiou, Giorgos K Sakkas, Marios Pantzaris

Abstract

Aim: To examine whether hemodialysis (HD) patients with restless legs syndrome (RLS) are subjects of greater fatigue and impaired quality of life (QoL) compared to HD patients without RLS.

Methods: Eighty five stable HD patients participated in this study. According to their RLS status, the patients were divided into the RLS group (n = 23) and the non-RLS group (n = 62). QoL, fatigue, sleep quality, daily sleepiness and depression symptoms were assessed by using various questionnaires. Finally, biochemical parameters including iron, ferritin, hemoglobin, hematocrit and parathormone were assessed.

Results: The HD patients with RLS scored worse in all the questionnaires used in the study (P < 0.05). The patients with RLS were more likely to receive the HD therapy on the morning shift, whilst 43.5% of the RLS patients reported to experience the RLS symptoms also during HD. The severity of RLS was correlated with fatigue, depression score and sleep quality (P < 0.05).

Conclusion: HD patients with RLS are subject to lower QoL related parameters and greater fatigue compared to HD patients without RLS. RLS should be successfully managed in order to improve the QoL of the sufferers.

Keywords: Depression; Fatigue; Quality of life; Secondary restless legs syndrome; Sleep quality.

Conflict of interest statement

Conflict-of-interest statement: None.

References

    1. Giannaki CD, Hadjigeorgiou GM, Karatzaferi C, Pantzaris MC, Stefanidis I, Sakkas GK. Epidemiology, impact, and treatment options of restless legs syndrome in end-stage renal disease patients: an evidence-based review. Kidney Int. 2014;85:1275–1282.
    1. Gkizlis V, Giannaki CD, Karatzaferi C, Hadjigeorgiou GM, Mihas C, Koutedakis Y, Stefanidis I, Sakkas GK. Uremic versus idiopathic restless legs syndrome: impact on aspects related to quality of life. ASAIO J. 2012;58:607–611.
    1. Gade K, Blaschke S, Rodenbeck A, Becker A, Anderson-Schmidt H, Cohrs S. Uremic restless legs syndrome (RLS) and sleep quality in patients with end-stage renal disease on hemodialysis: potential role of homocysteine and parathyroid hormone. Kidney Blood Press Res. 2013;37:458–463.
    1. Mucsi I, Molnar MZ, Ambrus C, Szeifert L, Kovacs AZ, Zoller R, Barótfi S, Remport A, Novak M. Restless legs syndrome, insomnia and quality of life in patients on maintenance dialysis. Nephrol Dial Transplant. 2005;20:571–577.
    1. Enomoto M, Inoue Y, Namba K, Munezawa T, Matsuura M. Clinical characteristics of restless legs syndrome in end-stage renal failure and idiopathic RLS patients. Mov Disord. 2008;23:811–816; quiz 926.
    1. Giannaki CD, Sakkas GK, Karatzaferi C, Hadjigeorgiou GM, Lavdas E, Liakopoulos V, Tsianas N, Koukoulis GN, Koutedakis Y, Stefanidis I. Evidence of increased muscle atrophy and impaired quality of life parameters in patients with uremic restless legs syndrome. PLoS One. 2011;6:e25180.
    1. Dikici S, Bahadir A, Baltaci D, Ankarali H, Eroglu M, Ercan N, Sav T. Association of anxiety, sleepiness, and sexual dysfunction with restless legs syndrome in hemodialysis patients. Hemodial Int. 2014;18:809–818.
    1. Giannaki CD, Sakkas GK, Hadjigeorgiou GM, Karatzaferi C, Patramani G, Lavdas E, Liakopoulos V, Koutedakis Y, Stefanidis I. Non-pharmacological management of periodic limb movements during hemodialysis session in patients with uremic restless legs syndrome. ASAIO J. 2010;56:538–542.
    1. Weisbord SD, Fried LF, Arnold RM, Fine MJ, Levenson DJ, Peterson RA, Switzer GE. Prevalence, severity, and importance of physical and emotional symptoms in chronic hemodialysis patients. J Am Soc Nephrol. 2005;16:2487–2494.
    1. Sakkas GK, Karatzaferi C. Hemodialysis fatigue: just “simple” fatigue or a syndrome on its own right? Front Physiol. 2012;3:306.
    1. Jhamb M, Liang K, Yabes J, Steel JL, Dew MA, Shah N, Unruh M. Prevalence and correlates of fatigue in chronic kidney disease and end-stage renal disease: are sleep disorders a key to understanding fatigue? Am J Nephrol. 2013;38:489–495.
    1. Allen RP, Picchietti DL, Garcia-Borreguero D, Ondo WG, Walters AS, Winkelman JW, Zucconi M, Ferri R, Trenkwalder C, Lee HB. Restless legs syndrome/Willis-Ekbom disease diagnostic criteria: updated International Restless Legs Syndrome Study Group (IRLSSG) consensus criteria--history, rationale, description, and significance. Sleep Med. 2014;15:860–873.
    1. Walters AS, LeBrocq C, Dhar A, Hening W, Rosen R, Allen RP, Trenkwalder C. Validation of the International Restless Legs Syndrome Study Group rating scale for restless legs syndrome. Sleep Med. 2003;4:121–132.
    1. Ware JE. SF-36 health survey update. Spine (Phila Pa 1976) 2000;25:3130–3139.
    1. Krupp LB, LaRocca NG, Muir-Nash J, Steinberg AD. The fatigue severity scale. Application to patients with multiple sclerosis and systemic lupus erythematosus. Arch Neurol. 1989;46:1121–1123.
    1. Zung WW. A self-rating depression scale. Arch Gen Psychiatry. 1965;12:63–70.
    1. Johns MW. A new method for measuring daytime sleepiness: the Epworth sleepiness scale. Sleep. 1991;14:540–545.
    1. Buysse DJ, Reynolds CF, Monk TH, Berman SR, Kupfer DJ. The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research. Psychiatry Res. 1989;28:193–213.
    1. Al-Jahdali HH, Al-Qadhi WA, Khogeer HA, Al-Hejaili FF, Al-Ghamdi SM, Al Sayyari AA. Restless legs syndrome in patients on dialysis. Saudi J Kidney Dis Transpl. 2009;20:378–385.
    1. Bossola M, Vulpio C, Tazza L. Fatigue in chronic dialysis patients. Semin Dial. 2011;24:550–555.
    1. Giannaki CD, Sakkas GK, Karatzaferi C, Hadjigeorgiou GM, Lavdas E, Kyriakides T, Koutedakis Y, Stefanidis I. Effect of exercise training and dopamine agonists in patients with uremic restless legs syndrome: a six-month randomized, partially double-blind, placebo-controlled comparative study. BMC Nephrol. 2013;14:194.
    1. Giannaki CD, Hadjigeorgiou GM, Karatzaferi C, Maridaki MD, Koutedakis Y, Founta P, Tsianas N, Stefanidis I, Sakkas GK. A single-blind randomized controlled trial to evaluate the effect of 6 months of progressive aerobic exercise training in patients with uraemic restless legs syndrome. Nephrol Dial Transplant. 2013;28:2834–2840.
    1. Sakkas GK, Giannaki CD, Karatzaferi C, Maridaki M, Koutedakis Y, Hadjigeorgiou GM, Stefanidis I. 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. 2015;21:39–49.
    1. Giannaki CD, Sakkas GK, Karatzaferi C, Maridaki MD, Koutedakis Y, Hadjigeorgiou GM, Stefanidis I. Combination of Exercise Training and Dopamine Agonists in Patients with RLS on Dialysis: A Randomized, Double-Blind Placebo-Controlled Study. ASAIO J. 2015;61:738–741.
    1. Bastos JP, Sousa RB, Nepomuceno LA, Gutierrez-Adrianzen OA, Bruin PF, Araújo ML, Bruin VM. Sleep disturbances in patients on maintenance hemodialysis: role of dialysis shift. Rev Assoc Med Bras (1992) 2007;53:492–496.
    1. Kutner NG, Zhang R, Szczech LA, Bliwise DL. Restless legs syndrome reported by incident haemodialysis patients: is treatment time of day relevant? Nephrology (Carlton) 2012;17:783–784.
    1. Araujo SM, de Bruin VM, Nepomuceno LA, Maximo ML, Daher Ede F, Correia Ferrer DP, de Bruin PF. Restless legs syndrome in end-stage renal disease: Clinical characteristics and associated comorbidities. Sleep Med. 2010;11:785–790.
    1. Jhamb M, Weisbord SD, Steel JL, Unruh M. Fatigue in patients receiving maintenance dialysis: a review of definitions, measures, and contributing factors. Am J Kidney Dis. 2008;52:353–365.
    1. Winkelmann J, Polo O, Provini F, Nevsimalova S, Kemlink D, Sonka K, Högl B, Poewe W, Stiasny-Kolster K, Oertel W, et al. Genetics of restless legs syndrome (RLS): State-of-the-art and future directions. Mov Disord. 2007;22 Suppl 18:S449–S458.
    1. Winkelmann J, Wetter TC, Collado-Seidel V, Gasser T, Dichgans M, Yassouridis A, Trenkwalder C. Clinical characteristics and frequency of the hereditary restless legs syndrome in a population of 300 patients. Sleep. 2000;23:597–602.
    1. Winkelmann J, Stautner A, Samtleben W, Trenkwalder C. Long-term course of restless legs syndrome in dialysis patients after kidney transplantation. Mov Disord. 2002;17:1072–1076.
    1. Aritake-Okada S, Nakao T, Komada Y, Asaoka S, Sakuta K, Esaki S, Nomura T, Nakashima K, Matsuura M, Inoue Y. Prevalence and clinical characteristics of restless legs syndrome in chronic kidney disease patients. Sleep Med. 2011;12:1031–1033.
    1. Trenkwalder C, Allen R, Högl B, Paulus W, Winkelmann J. Restless legs syndrome associated with major diseases: A systematic review and new concept. Neurology. 2016;86:1336–1343.
    1. Szentkiralyi A, Molnar MZ, Czira ME, Deak G, Lindner AV, Szeifert L, Torzsa P, Vamos EP, Zoller R, Mucsi I, et al. Association between restless legs syndrome and depression in patients with chronic kidney disease. J Psychosom Res. 2009;67:173–180.
    1. Bossola M, Luciani G, Tazza L. Fatigue and its correlates in chronic hemodialysis patients. Blood Purif. 2009;28:245–252.

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