Bliwise Donald L, Zhang Rebecca H, Kutner Nancy G
United States Renal Data System Rehabilitation/Quality of Life Special Studies Center and Department of Neurology, Emory University, Atlanta, GA, USA.
United States Renal Data System Rehabilitation/Quality of Life Special Studies Center and Department of Neurology, Emory University, Atlanta, GA, USA.
Sleep Med. 2014 Oct;15(10):1241-5. doi: 10.1016/j.sleep.2014.05.011. Epub 2014 Jun 13.
The objective of this study was to determine the association between the usage of four classes of "at-risk" medications (antidepressants, neuroleptics, antihistamines, and antiemetics with dopamine blockade) and restless legs syndrome (RLS) in dialysis patients within the United States Renal Data System (USRDS).
This was a case-control design within a national (United States) patient registry of all patients with end-stage renal disease (ESRD) in the USRDS anytime during the period of 1 October 2006 to 31 December 2010, inclusive. A total of 16,165 ESRD patients (3234 cases; 12,931 age-, sex-, and race-matched controls) were studied.
All four classes of "at-risk" medications see widespread use among patients in the USRDS. All were associated with increased odds of an RLS diagnosis (range of odds ratios, 1.47-2.28; all p < 0.0001) during the period of observation. Results were unchanged when controlling for time on hemodialysis. Usage of more than one class of medication increased the odds for having RLS.
ESRD patients often receive medication intended for relief of conditions associated with their disease, such as depression and psychological issues, pruritus, and gastroparesis; however, such medications may increase the risk of RLS. Given the high prevalence of RLS in ESRD patients, these medications should only be used when their benefits clearly outweigh the risk of development of the troubling and distressing symptoms of RLS.
本研究的目的是在美国肾脏数据系统（USRDS）中确定四类“有风险”药物（抗抑郁药、抗精神病药、抗组胺药以及具有多巴胺阻断作用的止吐药）的使用与透析患者不安腿综合征（RLS）之间的关联。
这是一项病例对照研究，纳入了2006年10月1日至2010年12月31日期间（含）USRDS中所有终末期肾病（ESRD）患者的全国性（美国）患者登记数据。共研究了16,165例ESRD患者（3234例病例；12,931例年龄、性别和种族匹配的对照）。
USRDS中的患者广泛使用所有这四类“有风险”药物。在观察期间，所有这些药物都与RLS诊断几率增加相关（优势比范围为1.47 - 2.28；所有p < 0.0001）。在控制血液透析时间后，结果不变。使用不止一类药物会增加患RLS的几率。
ESRD患者经常接受旨在缓解与其疾病相关状况的药物治疗，如抑郁和心理问题、瘙痒以及胃轻瘫；然而，此类药物可能会增加RLS的风险。鉴于ESRD患者中RLS的高患病率，只有当这些药物的益处明显超过出现RLS令人烦恼和痛苦症状的风险时，才应使用。
