title: Uremic restless legs syndrome (RLS) and sleep quality in patients with end-stage renal disease on hemodialysis: potential role of homocysteine and parathyroid hormone.
abstract: BACKGROUND
  The aetiology of uremic restless legs syndrome (RLS) remains unclear. Our research investigated whether an elevated plasma concentration of the excitatory amino acid homocysteine might be associated with RLS occurrence in patients with chronic renal insufficiency on hemodialysis.
  
  
  METHODS
  Total plasma homocysteine as well as creatinine, urea, folate, parathyroid hormone, hemoglobin, iron, ferritin, phosphate, calcium, magnesium, and albumin levels were compared between 26 RLS-affected (RLSpos) and 26 non-affected (RLSneg) patients on chronic hemodialysis. We further compared subjective sleep quality between RLSpos and RLSneg patients using the Pittsburgh-Sleep-Quality-Index and investigated possible relationships between laboratory parameters and sleep quality.
  
  
  RESULTS
  Taking individual albumin concentrations into account, a significant positive correlation between total plasma homocysteine and RLS occurrence was observed (r= 0.246; p=0.045). Sleep quality was significantly more reduced in RLSpos compared to RLSneg patients and RLS severity correlated positively with impairment of sleep quality. Bad sleep quality in all patients was associated with higher concentrations of parathyroid hormone.
  
  
  CONCLUSIONS
  Our results suggest a possible aetiological role of homocysteine in uremic RLS. They confirm that uremic RLS is an important factor causing sleep impairment in patients on hemodialysis. Higher parathyroid hormone levels might also be associated with bad sleep quality in these patients.
authors.affiliation: Department of Psychiatry and Psychotherapy, Georg-August-University Göttingen, Germany.
authors.forename: Katrin
authors.initials: K
authors.lastname: Gade
authors.forename: Sabine
authors.initials: S
authors.lastname: Blaschke
authors.forename: Andrea
authors.initials: A
authors.lastname: Rodenbeck
authors.forename: Andreas
authors.initials: A
authors.lastname: Becker
authors.forename: Heike
authors.initials: H
authors.lastname: Anderson-Schmidt
authors.forename: Stefan
authors.initials: S
authors.lastname: Cohrs
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D005260:Female; D006710:Homocysteine / Q000097:blood*; D006801:Humans; D007676:Kidney Failure, Chronic / Q000097:blood* / Q000175:diagnosis / Q000628:therapy; D008297:Male; D008875:Middle Aged; D010281:Parathyroid Hormone / Q000097:blood*; D006435:Renal Dialysis / Q000009:adverse effects; D012148:Restless Legs Syndrome / Q000097:blood* / Q000175:diagnosis / Q000628:therapy; D012890:Sleep / Q000502:physiology; D014511:Uremia / Q000097:blood* / Q000175:diagnosis / Q000628:therapy
chemical_list: D015415:Biomarkers; D010281:Parathyroid Hormone; D006710:Homocysteine