title: Restless legs syndrome is associated with cardio/cerebrovascular events and mortality in end-stage renal disease.
abstract: OBJECTIVE
  Earlier studies suggested an association between idiopathic restless legs syndrome (RLS) and cardiovascular diseases. However, the risk of cardiovascular events in patients with secondary RLS due to end-stage renal disease (ESRD) is unclear. Our aim was to examine whether ESRD patients with RLS had an increased risk of cardio/cerebrovascular events and mortality.
  
  
  METHODS
  In all, 1093 ESRD patients were recruited between 2009 and 2010. The diagnosis and severity of RLS were assessed in a face-to-face interview. The occurrence of cardio/cerebrovascular events and death were confirmed by medical record review. The association between RLS and the outcomes of interest was examined using an adjusted multivariate Cox regression model.
  
  
  RESULTS
  After a mean follow-up period of 3.7 ± 0.8 years, ESRD patients with RLS had a significantly higher risk of developing cardiovascular events and strokes [adjusted hazard ratio (aHR) 2.82, 95% confidence interval (CI) 2.02-4.11, and aHR 2.41, 95% CI 1.55-3.75, respectively] compared with patients without RLS. Increasing RLS severity was associated with an increasing likelihood of cardiovascular events [mild RLS severity, aHR 1.71 (95% CI 1.02-2.87); moderate, 2.79 (1.64-4.66); severe, 2.85 (1.99-4.46)] and strokes [mild, 1.89 (0.87-4.16); moderate, 2.42 (1.50-3.90); severe, 2.64 (1.49-4.91)] in a dose-dependent manner. RLS also increased the risk of total mortality in patients with ESRD [aHR 1.53 (95% CI 1.07-2.18), P = 0.02]; this association attenuated slightly after stratification by individual RLS severity category [mild RLS severity, aHR 1.44 (95% CI 0.78-2.67); moderate, 1.49 (0.98-2.55); severe, 2.03 (0.93-4.45)].
  
  
  CONCLUSIONS
  ESRD patients with RLS demonstrated an increased likelihood of cardio/cerebrovascular events and mortality.
authors.affiliation: Department of Neurology, College of Medicine, National Taiwan University Hospital, Taipei, Taiwan.
authors.forename: C-H
authors.initials: CH
authors.lastname: Lin
authors.forename: H-N
authors.initials: HN
authors.lastname: Sy
authors.forename: H-W
authors.initials: HW
authors.lastname: Chang
authors.forename: H-H
authors.initials: HH
authors.lastname: Liou
authors.forename: C-Y
authors.initials: CY
authors.lastname: Lin
authors.forename: V-C
authors.initials: VC
authors.lastname: Wu
authors.forename: S-L
authors.initials: SL
authors.lastname: Wu
authors.forename: C-C
authors.initials: CC
authors.lastname: Chang
authors.forename: P-F
authors.initials: PF
authors.lastname: Chiu
authors.forename: W-Y
authors.initials: WY
authors.lastname: Li
authors.forename: S-Y
authors.initials: SY
authors.lastname: Lin
authors.forename: K-D
authors.initials: KD
authors.lastname: Wu
authors.forename: Y-M
authors.initials: YM
authors.lastname: Chen
authors.forename: R-M
authors.initials: RM
authors.lastname: Wu
mesh_terms: D000368:Aged; D002318:Cardiovascular Diseases / Q000453:epidemiology* / Q000401:mortality; D002561:Cerebrovascular Disorders / Q000453:epidemiology / Q000401:mortality; D015897:Comorbidity; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D012148:Restless Legs Syndrome / Q000453:epidemiology* / Q000209:etiology; D012720:Severity of Illness Index
keywords: cardiovascular disease; cerebrovascular disease; end-stage renal disease; mortality; restless legs syndrome; stroke