Restless legs syndrome does not affect 3-year mortality in hemodialysis patients

Abstract

This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. Original Highlights of the studyWe evaluated the relationship of RLS and mortality in chronic hemodialysis patients For the diagnosis of RLS we implemented standard methodology, i.e. the essential clinical criteria of the International RLS Study Group. This is the first time this issue is investigated in an epidemiological survey in Greece.In contrast to previous reports the diagnosis of RLS does not influence the 3-year mortality in HD patients. ABSTRACTObjective: In chronic hemodialysis (HD) patients, the prevalence of restless legs syndrome (RLS) is significantly higher than in the general population. Uremic RLS has been related to an enhanced mortality of HD patients. In the general population, however, studies of this association have yielded inconsistent results. The aim of the present study was to re-evaluate the relationship of RLS and mortality in HD patients. Methods:We recorded the 3-year mortality rate in a population of 579 HD patients after assessment for RLS symptoms. In addition we analyzed the 5-year mortality rate after end-stage renal disease onset (i.e., commencement of HD). This HD patient population has been previously included in a cross-sectional survey of RLS prevalence in which RLS diagnosis was based on the essential clinical criteria of the International RLS Study Group. Mortality data were acquired from the national endstage renal disease registry. Survival probability was calculated by means of the Kaplan-Meier method and analyzed by the log-rank (Mantel-Cox) test. For multivariate survival analysis, we implemented a proportional hazards regression Conclusion: Diagnosis of RLS according to the essential clinical criteria of theInternational RLS Study Group does not seem to influence the 3-year mortality in HD patients. Our findings are in contrast to those in some previous reports, and reinforce the need for further studies of RLS and mortality in HD patients.

Survival of Dialysis Patients with Restless Legs Syndrome: A 15-Year Follow-Up Study

“…Some studies also found that RLS/WED is associated with enhanced mortality in ESRD patients [6,8,11,22,25], particularly those with severe forms of RLS/WED [8,11]. By contrast, Stefanidis et al [26] recently reported that RSL/WED did not influence the 3-year mortality rate in a large cohort of ESRD patients, sparking a debate on the impact of RSL/WED on mortality in patients on haemodialysis (HD) [27,28]. …”

Uremic Restless Legs Syndrome Pleads “Not Guilty”

“…In addition, the study by Baiardi et al [7] revealed no difference among the causes of death between the 2 groups; this is in contrast to previous studies linking RLS to cardiovascular diseases [5] . The studies by Stefanidis et al [6] and Baiardi et al [7] clearly suggest that mortality in HD patients is not influenced by the presence of RLS/WED, as they provide no clinical evidence linking uremic RLS/ WED to cardiovascular mortality.Considering the discordant literature on the mortality risk in uremic RLS patients and the fact that cardiovascular disease is the number one cause of death in HD patients, the recent evidence by Baiardi et al [7] provides important data that will inform the design of the next prospective Disorders of the brain are becoming more prevalent and are both threatening quality of life as well as creating major challenges for the national health systems. Restless legs syndrome (RLS; or Willis/Ekbom disease) is one of the most common neurological disorders associated with significant personal, social and economic burden.…”

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there was no significant association between RLS and 3-year mortality, either with age and gender as covariates [6] .In the current issue of the American Journal of Nephrology , an unprecedented 15-year follow-up of RLS survivorship is presented by Baiardi et al [7] . These investigators demonstrate that RLS-HD patients had a lower mortality rate compared to those HD patients without the syndrome (63.8% [4.3%/year] RLS-HD vs. 87.6% [5.8%/year] non-RLS HD, p = 0.04).

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“…Uremic RLS is frequently associated with increased morbidity and enhanced mortality in HD patients, linked to cardiovascular diseases [5] . A recent 3-year mortality study was the first to show that the diagnosis of RLS, according to the essential criteria of the International RLS Study Group, does not affect mortality in HD patients [6] . The mortality rate was 15.6% (5.2%/year) in RLS-HD patients and 22.3% (7.4%/year) in non-RLS HD patients.…”

Cardiovascular comorbidity in patients with restless legs syndrome: current perspectives

“…116 However, a recent study could not confirm an increased mortality in ESRD patients with RLS at 3-year follow-up (N=549). 117 Thus, the association between mortality and RLS/PLMS is not definitive at this time, reinforcing the need for further studies.…”