Current trends in the management of uremic restless legs syndrome: A systematic review on aspects related to quality of life, cardiovascular mortality and survival

Sakkas, Giorgos K.; Giannaki, Christoforos D.; Karatzaferi, Christina; Maridaki, Μaria; Koutedakis, Yiannis; Hadjigeorgiou, Georgios M.; Stefanidis, Ioannis

doi:10.1016/j.smrv.2014.07.006

Cited by 48 publications

(29 citation statements)

References 88 publications

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“…Thus, gabapentin may exhibit multiple therapeutic benefits in patients with hypertension and psychotic disorders. Gabapentin treatment for 4 weeks showed an improvement of 82% of the symptom severity of restless legs syndrome, which may be associated with cardiovascular mortality and survival in the uremic patients3132. We look forward to the future, as gabapentin could have the multiple therapeutic benefits in patients with hypertension and psychotic disorders.…”

Section: Discussionmentioning

confidence: 96%

Renal Denervation Improves the Baroreflex and GABA System in Chronic Kidney Disease-induced Hypertension

Chen

Cheng

et al. 2016

Sci Rep

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Hypertensive rats with chronic kidney disease (CKD) exhibit enhanced gamma-aminobutyric acid (GABA) B receptor function and regulation within the nucleus tractus solitarii (NTS). For CKD with hypertension, renal denervation (RD) interrupts the afferent renal sympathetic nerves, which are connecting to the NTS. The objective of the present study was to investigate how RD improves CKD-induced hypertension. Rats underwent 5/6 nephrectomy for 8 weeks, which induced CKD and hypertension. RD was induced by applying phenol to surround the renal artery in CKD. RD improved blood pressure (BP) by lowering sympathetic nerve activity and markedly restored the baroreflex response in CKD. The GABA B receptor expression was increased in the NTS of CKD; moreover, the central GABA levels were reduced in the cerebrospinal fluid, and the peripheral GABA levels were increased in the serum. RD restored the glutamic acid decarboxylase activity in the NTS in CKD, similar to the effect observed for central treatment with baclofen, and the systemic administration of gabapentin reduced BP. RD slightly improved renal function and cardiac load in CKD. RD may improve CKD-induced hypertension by modulating the baroreflex response, improving GABA system dysfunction and preventing the development and reducing the severity of cardiorenal syndrome type 4 in CKD rats.Hypertension occurs in more than 80% of patients with chronic kidney disease (CKD) 1 . Patients with CKD have a higher risk of developing cardiovascular diseases than the general population 2,3 . Multiple guidelines discuss the importance of lowering blood pressure (BP) to slow the progression of renal disease and reduce cardiovascular morbidity and mortality 4 . However, to achieve and maintain adequate BP control, most patients with CKD require multiple antihypertensive agents. Despite the increasing prevalence of CKD-induced hypertension, the awareness of hypertension among individuals with CKD remains suboptimal, and the rates of BP control remain poor 5 . Recently, many studies have provided evidence that renal denervation (RD) has beneficial effects in patients with CKD-induced hypertension 6 . However, RD improves CKD progression through unknown mechanisms.

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Section: Discussionmentioning

confidence: 96%

Renal Denervation Improves the Baroreflex and GABA System in Chronic Kidney Disease-induced Hypertension

Chen

Cheng

et al. 2016

Sci Rep

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“…Our incidence of RLS (13 women vs. 6 men), as well as evidence from different scenarios clearly indicate that RLS is approximately twice as prevalent in women as in men [4, 7, 15, 16]; this has been related to interactions between estrogens and dopamine. RLS is worsened by pregnancy and post-menopausal estrogen use, and improves with delivery and prolactin [17, 24].…”

Section: Discussionmentioning

confidence: 61%

“…The pathogenesis of the disorder is unclear; however, it has been associated with the dysregulation of dopaminergic function and/or iron metabolism in the brain [15]. Female predominance in RLS may also point to estrogen-related pathways in this syndrome [16-18].…”

Section: Introductionmentioning

confidence: 99%

Restless Legs Syndrome: An Unresolved Uremic Disorder after Renal Transplantation

Calviño

Cigarrán

González-Tabarés

et al. 2018

Nephron

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Background: Restless legs syndrome (RLS) is a common complication of uremia that may improve after transplantation. Its frequency might not be as low as expected, as some uremic disturbances may continue even after a successful graft. Our aim was to investigate the prevalence and related conditions for RLS in renal transplant patients. Methods: We carried out a cross-sectional, observational study. A self-administered questionnaire following the International Restless Legs Syndrome Study Group diagnostic criteria was administered to 129 patients (82 men and 47 women) aged 57 ± 12.8 years followed up for at least 1 year, with stable renal function (Cr 1.5 ± 0.54 mg/dL). Patients with probable RLS according to the screening questionnaire underwent comprehensive neurological examination to exclude RLS mimics. Results: The frequency of RLS according to questionnaires was 29.5% (18 men/20 women). After neurological exam, RLS was confirmed in 19 patients providing an overall frequency of 14.8% (higher than the prevalence in the general population). A definitive diagnosis of RLS was established for 6 men (7.3%) and 13 women (27.7%), indicating a positive predictive value for the screening questionnaire of 65% for women and 33% for men. There were fewer patients under renin-angiotensin aldosterone system (RAAS) blocking treatment in the RLS group (21.1 vs. 47.3%). Women with RLS had poorer renal function (52 ± 17.5 vs. 42 ± 13.9 mL/min) and phosphate-reabsorption rate (75 ± 10.5 vs. 65 ± 9.2). There was no difference in age, comorbidities, anticalcineurin therapy, renal function, anemia and time since transplantation between transplant patients with and without RLS. Conclusion: The prevalence of RLS after transplantation remains high (14.8%). This condition is twice more prevalent for females. Contribution of RAAS, graft function and phosphate overload requires further investigation.

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“…10 Box B. Sources of information used Established sources American Hospital Formulary Service Drug Information 7 Martindale: The Complete Drug Reference 8 Oxford Specialist Handbook: Kidney disease from advanced disease to bereavement 9 Package Inserts (USA) Renal Drug Database 10 Summary of Product Characteristics (UK) Additional sources Antidepressants [11][12][13][14][15][16] Anti-emetics 17,18 Anti-epileptics [19][20][21][22][23] Benzodiazepines [24][25][26] Miscellaneous drugs 27,28 Prescribing advice 1,12,[29][30][31][32][33] Antidepressants (Table 1) Low starting doses and cautious titration are required for all antidepressants, regardless of whether they (AE any active metabolites) are renally excreted. In ESKD there is an increased sensitivity to drugs acting on the CNS coupled with a risk of enhanced central depressant effects from the variable pharmacokinetic changes (Box A), e.g.…”

Section: Drug Dosing In Dialysismentioning

confidence: 99%

Prescribing Non-Opioid Drugs in End-Stage Kidney Disease

Wilcock

Charlesworth

Twycross

et al. 2017

Journal of Pain and Symptom Management

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Therapeutic Reviews aim to provide essential independent information for health professionals about drugs used in palliative and hospice care. Additional content is available on www.palliativedrugs.com. Country-specific books (Hospice and Palliative Care Formulary USA, and Palliative Care Formulary, British and Canadian editions) are also available and can be ordered from www.palliativedrugs.com. The series editors welcome feedback on the articles (hq@palliativedrugs.com).

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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

Cited by 48 publications

References 88 publications

Renal Denervation Improves the Baroreflex and GABA System in Chronic Kidney Disease-induced Hypertension

Renal Denervation Improves the Baroreflex and GABA System in Chronic Kidney Disease-induced Hypertension

Restless Legs Syndrome: An Unresolved Uremic Disorder after Renal Transplantation

Prescribing Non-Opioid Drugs in End-Stage Kidney Disease

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