An Intradialysis Diagnostic Test for Restless Legs Syndrome: A Pilot Study

Epidemiology, impact, and treatment options of restless legs syndrome in end-stage renal disease patients: an evidence-based review

“…In one study, 4 weeks of treatment with the dopamine agonist pergolide (initial dose of 0.05 mg per day at night, increased gradually by 0.05 mg per day steps) was found to be effective in reducing, among others, the PLM during HD session. 26 In a recent study by our group, even acute intradialytic exercise (cycling), independently of intensity, was effective in the amelioration of RLS motor symptoms expressed as PLM/ index per hour of HD. 15 Thus, it seems that both dopamine agonists and intradialytic exercise training (whether acute or chronic) could be effective as interventions for the management of uremic RLS symptoms appearing during the HD sessions.…”

“…In particular, treatment with gabapentin was associated with somnolence and lethargy 46 and severe side effects in one patient (no details were provided); 47 levodopa was associated with vomiting, 7 general weakness, and Wegener's granulomatosis; 42 and pergolideuse was associated with nausea, headache, somnolence, emesis, vomiting, and nightmares at least at the initial phase of the treatment. 26,45 No considerable adverse effects were reported with ropinirole 7 or pramipexole treatment. 44…”

“…However, we should note the high dropout rates in that study, as well as that some patients reported a series of adverse effects, such as vomiting, nausea, emesis, and nightmares. In the study of Kume et al, 26 pergolide with an initial dose of 0.05 mg per day at night (which was increased gradually with 0.05 mg per day steps until satisfactory amelioration of the RLS symptoms) for 4 weeks was found to significantly ameliorate uremic RLS symptoms by approximately 60%. 26 However, even though uremic patients find relief from RLS symptoms with dopamine agonist treatments, one study reported that these patients present a decreased response to this kind of drugs compared with the patients with idiopathic RLS, implying a type of drug resistance.…”

“…In the study of Kume et al, 26 pergolide with an initial dose of 0.05 mg per day at night (which was increased gradually with 0.05 mg per day steps until satisfactory amelioration of the RLS symptoms) for 4 weeks was found to significantly ameliorate uremic RLS symptoms by approximately 60%. 26 However, even though uremic patients find relief from RLS symptoms with dopamine agonist treatments, one study reported that these patients present a decreased response to this kind of drugs compared with the patients with idiopathic RLS, implying a type of drug resistance. 29 Uremic RLS symptom severity was significantly reduced after treatment with the anticonvulsant gabapentin (200-300 mg three times per week after the end of the HD session).…”

“…Many nephrologists and neurologists believe that the development of specific diagnostic criteria could help for an early and accurate diagnosis of RLS in the ESRD population (personal communication). In a recent pilot study from Kume and co-workers, 26 a Holter-monitored suggested immobilization test during HD session was used successfully for the diagnosis of uremic RLS; however, further research is needed in order to increase the sensitivity of this method.…”