Uremic Restless Legs Syndrome Pleads “Not Guilty”

Abstract

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). Similarly, the mortality rate was not influenced by gender ( p = 0.15) and even more importantly by RLS severity ( p = 0.11). 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. With an adult prevalence of approximately 2.7% in the general population, RLS is underdiagnosed [1] . It is estimated to affect 20 million European citizens and many more around the world. Recent data from the "value of treatment for brain disorders" research project, conducted by the European Brain Council [2] , demonstrated that RLS is the fifth most expensive neurological disorder after mood disorders and dementia.Notably, RLS prevalence in hemodialysis (HD) patients is much higher than in the general population reaching approximately 30% [3,4] . 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. Moreover,

Dialysis Patients With Restless Leg Syndrome: Can We Relieve Their Suffering?

“…Takaki et al reported that RLS is significantly associated with higher anxiety prevalence in hemodialysis patients [13]. On the other hand, Sakkas et al found that although RLS is associated with other morbidities, it does not affect the mortality rate in ESRD patients and still the cardiovascular cause is the first contributor to the mortality rate in ESRD [28]. The same results were reported in a study by Baiardi et al conducted on 128 ESRD patients on hemodialysis [29].…”