Restless Legs Syndrome - RLS in Kidney Failure and Dialysis (en Inglés) - Khosro Hekmat

When the legs will not rest on dialysis.

About 24 to 28% of people on dialysis have restless legs syndrome, according to the large syntheses, and a review estimates that it is two to three times as common as in the general population. Yet it usually goes unrecognised. In one dialysis unit only one of 28 patients with RLS had been diagnosed and treated. Many people take the evening urge to move for part of the kidney disease or of old age, and nobody asks.

The consequences reach well beyond the legs. Dialysis imposes hours of rest, exactly the situation in which RLS appears. In one study 43.5% of the patients with RLS felt their symptoms during the session. In an older study, 20% of the patients who answered the question had ended a dialysis session early at least once, for any reason, and more severe restless-legs symptoms were associated with this. A shortened session removes less waste from the blood. Sleep, exhaustion, mood and quality of life are affected too.

This volume explains which mechanisms may contribute to RLS in chronic kidney disease: iron that is present but cannot be used, the hormone hepcidin and the build-up of substances that healthy kidneys would excrete. None of this has been proven. It sets out why a ferritin concentration of more than 300 µg/l does not settle the question, because inflammation raises ferritin while usable iron may remain locked away. It distinguishes RLS from calf cramps, nerve damage and drug-induced restlessness, and reads the figures on the heart and life expectancy without alarm.

Treatment follows a stepwise approach: remove aggravating factors, check iron, make better use of dialysis, and only then medicines chosen for impaired kidney function. The book explains why some agents accumulate and why gabapentin is given after each dialysis session. After a successful kidney transplant the symptoms disappear in most people, and if the graft fails they often return, which is strong evidence that kidney failure contributes to the symptoms. Exercise training gets particular attention: in the first randomised controlled study RLS severity fell by 58%, and in a direct comparison exercise training reduced it by 46% and ropinirole by 54%.

Further chapters look at sleep on dialysis beyond the legs, at what helps during the session itself, at gentle measures at home, and at children with kidney disease, 21% of whom had RLS in a meta-analysis. A note to take to the next appointment brings it all together.

WHAT IS IN THE BOOK

- How common RLS is in kidney disease, on dialysis and after transplantation

- Which mechanisms may contribute, and the role of iron and hepcidin

- What RLS means for sleep, dialysis sessions and quality of life

- The five diagnostic criteria, and how RLS differs from cramps and nerve damage

- RLS and the heart: what the figures on prognosis support

- Iron as the first step, and why its benefit is temporary

- Dialysis modality, parathyroid surgery and transplantation

- Which medicines suit kidney failure, and which accumulate

- Exercise training, stretching, vitamins C and E, massage: what the evidence shows

- Pedal trainer, acupressure and infrared light during the session

- Children and adolescents with chronic kidney disease

- Who is responsible for what, and what to write down for the appointment

WHO THIS BOOK IS FOR

For people receiving haemodialysis or peritoneal dialysis, for people with chronic kidney disease before dialysis, for transplant recipients and their families, and for everyone working in a dialysis unit.