title: Restless legs syndrome in end-stage renal disease: Clinical characteristics and associated comorbidities.
abstract: BACKGROUND
  Despite being frequently described in patients with end-stage renal disease (ESRD), clinical characteristics and comorbidities in association with restless legs syndrome (RLS) are still to be confirmed.
  
  
  OBJECTIVE
  The aim of this study was to investigate clinical factors associated with RLS in ESRD patients in hemodialysis.
  
  
  METHODS
  This is a cross-sectional study of 400 patients on hemodialysis, evaluating RLS, clinical features and other sleep abnormalities.
  
  
  RESULTS
  Out of 400, 86 patients presented RLS (21.5%; mean age 48.8+/-13.8y), being more frequent in females (p<0.005). Forty-eight individuals (12% mean age 50.7+/-13.1y) had moderate/severe RLS, 14 reported symptoms prior to hemodialysis, 13 described family history of RLS, and eight described symptoms as disturbing during dialysis. RLS cases showed lower hemoglobin (p<0.005), poorer quality of sleep (Pittsburgh Sleep Quality Index >5, p=0.002), higher scores on the Beck Depression Inventory Scale (p<0.005), greater scores on the Charlson Comorbidity Index (p=0.01) and the Epworth Sleepiness Scale (p=0.001) and higher risk of obstructive sleep apnea (OSA; Berlin questionnaire, p=0.01). Hypertension was more frequent in cases with moderate/severe RLS (p=0.01) and remained after controlling for the risk of OSA (p=0.02).
  
  
  CONCLUSIONS
  In ESRD patients in hemodialysis, RLS is present in 21.5%; 16% report symptoms prior to hemodialysis and a family history of RLS. Symptoms are disturbing during hemodialysis in 9% of cases. RLS is associated with lower hemoglobin, worse sleep quality, excessive daytime sleepiness, depressive symptoms and higher risk of OSA. Hypertension is associated with moderate/severe RLS.
authors.affiliation: Department of Medicine, Federal University of Ceara, Brazil.
authors.forename: Sonia Maria Holanda Almeida
authors.initials: SM
authors.lastname: Araujo
authors.forename: Veralice Meireles Sales
authors.initials: VM
authors.lastname: de Bruin
authors.forename: Lucas A
authors.initials: LA
authors.lastname: Nepomuceno
authors.forename: Marcos Lelio
authors.initials: ML
authors.lastname: Maximo
authors.forename: Elizabeth de Francesco
authors.initials: Ede F
authors.lastname: Daher
authors.forename: Debora Praciano
authors.initials: DP
authors.lastname: Correia Ferrer
authors.forename: Pedro Felipe Carvalhedo
authors.initials: PF
authors.lastname: de Bruin
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D003430:Cross-Sectional Studies; D003863:Depression / Q000453:epidemiology / Q000503:physiopathology; D005260:Female; D006801:Humans; D006977:Hypertension, Renal / Q000453:epidemiology* / Q000503:physiopathology; D007676:Kidney Failure, Chronic / Q000453:epidemiology* / Q000503:physiopathology / Q000628:therapy; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis / Q000706:statistics & numerical data; D012148:Restless Legs Syndrome / Q000453:epidemiology* / Q000503:physiopathology; D012307:Risk Factors; D020181:Sleep Apnea, Obstructive / Q000453:epidemiology; D012894:Sleep Stages; D011795:Surveys and Questionnaires; D055815:Young Adult