Burden of Restless Leg Syndrome in Patients With End Stage Renal Disease Undergoing Maintenance Hemodialysis

Abstract

Background Restless leg syndrome (RLS) is an underestimated neurological condition in hemodialysis patients. Restless leg syndrome has a negative effect on the quality of sleep and life in these patients. In Kenya, chronic kidney disease is increasing due to non-communicable diseases such as hypertension and diabetes, and many patients are getting into hemodialysis treatment program. There is no published data on Restless Leg Syndrome in Kenyan Patients. Objectives To determine the prevalence of restless leg syndrome in patients with end stage renal disease patients undergoing hemodialysis, evaluate the severity of restless leg syndrome and determine the quality of sleep and life. Methods This was a multicenter cross-sectional study done at the renal units in Kenyatta National Hospital, Mbagathi District Hospital, Nairobi Hospital and the Parkland’s Kidney Center. The study participants were adults undergoing maintenance hemodialysis. Two hundred and seventy patients were undergoing maintenance hemodialysis at the four centers during the time of study. Consecutive sampling was used to recruit patients. 22 study subjects were excluded – 2 pregnant, 10 were on gabapentin and 10 declined consent. Eight (8) patients had dialyzed for less than three months, consequently 240 patients were recruited. After obtaining a written informed consent, demographic features; comorbidities, underlying cause of ESRD and dialysis history were collected using a study proforma. Diagnosis of Restless Leg Syndrome was established by administering International Restless Leg Syndrome Study Group 2012 questionnaire and severity of Restless Leg Syndrome was determined by administering the IRLSSG Severity Rating Scale; score of 31-40 was very severe, 21-30 was severe, 11-20 was moderate and 1-10 had mild Restless Leg Syndrome. Daytime sleepiness was determined by administering The Epworth Sleepiness Scale; a score of more than ten indicated a poor quality of sleep. Quality of life was determined by administering the 36 item short form health survey; a score of less than 50% indicated a poor quality of life. Data was analyzed in SPSS version 21.0. Results Two hundred and forty patients were recruited. The prevalence of Restless Leg Syndrome was 35.8% (95%confidence interval, [CI] 29.8 to 42.3). The mean age was 53.3 (SD 17.1) years. Ninety percent (n=78) patients had moderate to severe form of the disease. Forty two percent (n=101) of study subjects had poor quality of sleep. There was a strong association of Restless Leg Syndrome and poor quality of sleep (odds ratio, 15.5; 95% confidence interval [CI], 8.0 to 29.9; P< 0.001). Fifty one percent (n=123) of study subjects had a poor quality of life. Study subjects with Restless Leg Syndrome had a poor quality of life as compared to those without the syndrome (Odds ratio, 6.8; 95% Confidence Interval [CI], 3.7 to 12.6; P<0.001). Conclusion Restless Leg Syndrome is a common neurological condition among hemodialysis patients. It should be routinely looked for as it leads to a poor quality of sleep and life.