title: Restless legs symptoms among incident dialysis patients: association with lower quality of life and shorter survival.
abstract: BACKGROUND
  Symptoms of restless legs are common among patients treated with long-term hemodialysis. We investigated the relation between symptoms of restless legs, quality of life, and survival among incident hemodialysis and peritoneal dialysis patients.
  
  
  METHODS
  This report includes 894 dialysis patients who responded to an item regarding severity of restless legs symptoms in the Choices for Healthy Outcomes in Caring for End-Stage Renal Disease Study. We examined participant responses both as categorized by the 5-point symptoms of restless legs item and classified with severe symptoms of restless legs if they reported they were very or extremely bothered by symptoms. Independent predictors of restless legs symptoms were estimated using logistic regression. The association of restless legs symptoms with quality of life was examined by means of mixed-model regression, and adjusted mortality risk was estimated by means of Cox proportional hazards.
  
  
  RESULTS
  Fifteen percent of dialysis patients were classified as having severe restless legs. Those characterized by severe restless legs were significantly more likely to be administered benzodiazepines, antidepressants, and antiepileptics. Age and diabetes mellitus were independently associated with severe symptoms of restless legs. Symptoms of restless legs were associated with lower Physical and Mental Component Scores, vitality, bodily pain, and sleep quality (all P < 0.001). After adjustment, severe symptoms of restless legs were significantly associated with an increased mortality hazard ratio of 1.39 (95% confidence interval, 1.08 to 1.79).
  
  
  CONCLUSIONS
  Symptoms of restless legs were associated with lower quality of life and increased risk for death. The effect of treatment for symptoms of restless legs on quality of life and survival awaits additional study.
authors.affiliation: Renal-Electrolyte Division, University of Pittsburgh Medical Center, Pittsburgh, PA 15261, USA. unruh@pitt.edu
authors.forename: Mark L
authors.initials: ML
authors.lastname: Unruh
authors.forename: Andrew S
authors.initials: AS
authors.lastname: Levey
authors.forename: Carolyn
authors.initials: C
authors.lastname: D'Ambrosio
authors.forename: Nancy E
authors.initials: NE
authors.lastname: Fink
authors.forename: Neil R
authors.initials: NR
authors.lastname: Powe
authors.forename: Klemens B
authors.initials: KB
authors.lastname: Meyer
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006305:Health Status Indicators; D006801:Humans; D007676:Kidney Failure, Chronic / Q000401:mortality / Q000628:therapy; D008297:Male; D008875:Middle Aged; D010530:Peritoneal Dialysis / Q000009:adverse effects; D016016:Proportional Hazards Models; D011788:Quality of Life; D006435:Renal Dialysis / Q000009:adverse effects; D012148:Restless Legs Syndrome / Q000209:etiology / Q000503:physiopathology; D016019:Survival Analysis