| Objective The aims of this study were to investigate the prevalence of restless legs syndrome(RLS) in maintenance hemodialysis( MHD) patients in Hefei,analyze the possible associated risk factors of RLS in HD patients, compare sleep quality and health-related quality of life(HRQOL) with and without RLS in HD patients,and evaluate the effects of RLS on HD patients in anxiety and depression.Methods Adult MHD patients in 5 dialysis units in Hefei were studied between December 2013 and March 2014. All ESRD patients who have received regular hemodialysis for at least 3 months were included. Patients who were unwilling to participate in the survey, unable to give informed consent, unable to communicate, acute infection, dementia, pregnancy, coma, tumour and Parkinson’s disease were excluded. Socio-demographic parameters including age and gender, clinical information on renaldisease history, duration of dialysis therapy, type of dialysis, family history of restless legs syndrome,medical history and laboratory data before dialysis were collected.The International RLS Study Group diagnosis questionnaire was completed for the diagnosis of RLS. Patients were divided into two groups according to whether the patients diagnosed with restless legs syndrome.Socio-demographic parameters,clinical information on renaldisease history, duration of dialysis therapy, type of dialysis, family history of restless legs syndrome and laboratory data before dialysis were compared between patients with RLS and patients without RLS and then analyzed their association with RLS using multivariate logistic analyses. The Pittsburg Sleep Quality Index(PSQI) questionnaire was used to assess sleep quality,the Kidney Disease Quality of life questionnaire(KDQOLTM-36) was used for the analysis of HRQOL; the Zung Self-Rating Depression Scale(SDS) was completed for the evaluation of depression and Zung Self-Rating Anxiety Scale(SAS) for anxiety. The PSQI scores for sleep quality, HRQOL scores for quality of life,SDS scores for depression and SAS scores for anxiety were compared between two groups.Results 1.A total of 269 MHD patients including 81 women and 188 men were enrolled in this study. Mean age was 51.8±14.3years. The median duration of dialysis therapy was 33(12.5,69.0)months.39 patients were diagnosed as RLS. The prevalence of RLS was 14.50%.Patients with RLS had lower hemoglobin level(98.67±13.50 VS 106.34 ± 17.75g/l,P=0.011)and higher alkaline phosphatase concentration(131.0(98.0,226.0)VS 94.0(69.8,157.5)u/l, P=0.001)compared to those without;No significant difference in gender,age, type of dialysis, duration of dialysis therapy, predialysis blood urea nitrogen, creatinine, uric acid, serum phosphate, calcium, intact parathyroid hormone, ferritin,transferrin saturation and the presence of hypertension and diabetes mellitus was found between patients with and without RLS. The multivariate logistic regression analysis showed that high hemoglobin level(OR:0.975,95%CI(0.956-0.995),P=0.015) was protective factor of RLS and high alkaline phosphatase(OR:1.003,95%CI(1.001-1.005),P=0.018)was independent risk factor of RLS. 3. Patients with RLS had significantly higher scores on PSQI-Sum-score( 11.86±4.72 VS 7.90±4.39, P< 0.001),subjective sleep quality(1.89±0.81 vs 1.12±0.86,p< 0.001),sleep latency(2.00±1.03 vs 1.49±1.07,P <0.007,),sleep duration( 1.59±1.17 VS 0.90±1.01 P < 0.001),sleep efficiency(1.89±1.29 VS 1.14±1.26,P=0.001),sleep disturbances(2.50±0.51 VS 2.06±0.51P< 0.001) and daytime dysfunction( 1.62±0.95 VS 1.17±1.09, P=0.019).In KDQOLTM-36,general health score(32.64±16.71 VS 40.78±19.58,P=0.019), social emotions score(38.89±44.90 VS 58.99±44.62,P=0.013), energy / fatigue(37.78±26.09 VS 49.35±27.25,P=0.019), and symptoms/problems(69.51±19.74 VS 82.17±15.06,P<0.001) were significantly lower in in patients with RLS compared to those without. SAS score(37.61±8.75 VS 34.28±6.10,P=0.034)and SDS score(45.28±10.35 VS 40.07±10.10,P=0.005) were also significantly higher in RLS patients than non-RLS patients.Conclusions Our findings demonstrated that the prevalence of RLS was 14.50% in Heifei maintenance hemodialysis patients. High hemoglobin level was protective factor of RLS and high alkaline phosphatase was independent risk factor of RLS. RLS negatively affects many aspects of quality of life and sleep quality, and may contribute to the presence of depression and anxiety. |
PDF Full Text Request