Molnar Miklos Zsolt, Szentkiralyi Andras, Lindner Anett, Czira Maria Eszter, Szeifert Lilla, Kovacs Agnes Zsofia, Fornadi Katalin, Szabo Andras, Rosivall Laszlo, Mucsi Istvan, Novak Marta
Institute of Behavioral Sciences, Semmelweis University, Budapest, Hungary.
Am J Kidney Dis. 2007 Nov;50(5):813-20. doi: 10.1053/j.ajkd.2007.08.003.
Previous studies showed an association between the presence of restless legs syndrome (RLS) and mortality in patients on dialysis therapy. An association between RLS and cardiovascular risk also was reported in the general population. However, no prospective study to date assessed the association between the presence of RLS and mortality in kidney transplant recipients. In a prospective cohort study (Transplantation and Quality of Life-Hungary Study), we tested the hypothesis that the presence of RLS predicts mortality in transplant recipients.
Prospective cohort study was performed.
SETTINGS & PARTICIPANTS: 804 kidney transplant recipients followed up at a single outpatient transplant center were enrolled in the study. Sociodemographic parameters, laboratory data, and medical history were collected at baseline. Data for 4-year outcomes were collected prospectively from patient charts.
Presence of RLS assessed using the RLS Questionnaire.
OUTCOME & MEASUREMENTS: We defined 3 primary outcomes: mortality with functioning graft, return to dialysis therapy, and the combined outcome of these 2.
Mean age was 49 +/- 13 years, estimated glomerular filtration rate was 49 +/- 19 mL/min/1.73 m(2), and median time after transplantation was 54 months. During the 4 years, 97 patients died and 63 patients returned to dialysis therapy. Mortality at 4 years was significantly greater in patients who had RLS at baseline: univariate hazard ratio for the presence of RLS was 2.53 (95% confidence interval, 1.31 to 4.87). In multivariate Cox proportional hazard analysis, the presence of RLS significantly predicted mortality (hazard ratio, 2.02; 95% confidence interval, 1.03 to 3.95) after adjustment for several covariables.
The RLS Questionnaire was not validated in transplant recipients. We lacked information for key variables, including HLA mismatch, panel reactive antibodies, cold ischemic time, acute rejection episodes, viral infections, smoking status, and dyslipidemia.
RLS, a potentially treatable disease, is a significant risk factor for mortality in kidney transplant recipients.
先前的研究表明，不宁腿综合征（RLS）的存在与接受透析治疗的患者死亡率之间存在关联。在普通人群中也报道了RLS与心血管风险之间的关联。然而，迄今为止，尚无前瞻性研究评估肾移植受者中RLS的存在与死亡率之间的关联。在一项前瞻性队列研究（匈牙利移植与生活质量研究）中，我们检验了RLS的存在可预测移植受者死亡率这一假设。
进行前瞻性队列研究。
在一个门诊移植中心接受随访的804名肾移植受者被纳入研究。在基线时收集社会人口统计学参数、实验室数据和病史。前瞻性地从患者病历中收集4年结局的数据。
使用RLS问卷评估RLS的存在情况。
我们定义了3个主要结局：移植肾有功能时的死亡率、恢复透析治疗以及这两者的综合结局。
平均年龄为49±13岁，估计肾小球滤过率为49±19 mL/min/1.73 m²，移植后的中位时间为54个月。在4年期间，97名患者死亡，63名患者恢复透析治疗。基线时患有RLS的患者4年死亡率显著更高：RLS存在情况的单变量风险比为2.53（95%置信区间，1.31至4.87）。在多变量Cox比例风险分析中，在对多个协变量进行调整后，RLS的存在显著预测死亡率（风险比，2.02；95%置信区间，1.03至3.95）。
RLS问卷在移植受者中未经验证。我们缺乏关键变量的信息，包括HLA错配、群体反应性抗体、冷缺血时间、急性排斥反应发作、病毒感染、吸烟状况和血脂异常。
RLS是一种潜在可治疗的疾病，是肾移植受者死亡的重要危险因素。
