Nephrology, EOXI Lugo-Cervo-Monforte, Hospital Lucus Augusti, Lugo, Spain.
Nephrology, EOXI Lugo-Cervo-Monforte, Hospital da Costa, Burela, Lugo, Spain.
J Clin Sleep Med. 2015 Jan 15;11(1):57-60. doi: 10.5664/jcsm.4366.
Sleep disorders are frequent in chronic kidney disease (CKD). Among them, restless legs syndrome (RLS) may affect up to 60% of patients on dialysis, and it has been related to a poor quality of life and higher cardiovascular risk. Despite its high prevalence in advanced stages of renal disease, RLS frequency in non-dialysis CKD has not been clearly established. The aim of this study was to assess the frequency of RLS in non-dialysis CKD patients (stages 2 to 4) followed in a reference nephrology outpatient clinic.
A standardized questionnaire following the international RLS study group diagnostic criteria was self-administered by 110 patients regularly followed in the nephrology clinic. The series comprised 69 men and 41 women, aged 68 ± 13.2 years, with mean serum creatinine of 1.7 ± 0.8 mg/dL. Subsequently, patients classified as probable RLS according to the questionnaire underwent a systematic neurological examination. The presence of peripheral artery disease was evaluated by the ankle-brachial index (ABI).
The frequency of probable RLS according to the questionnaire results was 21% (17% for men and 27% for women). However, after thorough neurological examination, the diagnosis of RLS was confirmed in only 5 patients. Therefore, the overall definitive RLS frequency was 4.5% (within the prevalence reported for the general population) and was higher among women (9.7% vs 0.2%). In the remaining cases symptoms were due to leg discomfort related with other disorders. Patients with probable and improbable RLS were not significantly different in age, ABI, diabetes, and other comorbid circumstances, except for tricyclic antidepressant prescription, which was more frequent in the probable RLS group (17% vs 2%). Renal function was better in definitive RLS patients than cases classified as probable RLS by the questionnaire but not confirmed after neurological exam.
Although RLS can represent an early manifestation of CKD, its prevalence seems very close to that reported for the general population. Diagnostic confirmation of RLS dramatically falls after expert examination, raising the question whether, in the study of RLS cohorts, CKD has a potentially causal relationship or is a confounding factor associated with other causes of leg discomfort.
睡眠障碍在慢性肾脏病（CKD）中很常见。其中，不宁腿综合征（RLS）可能影响多达 60%的透析患者，并且与生活质量差和更高的心血管风险有关。尽管 RLS 在肾脏疾病的晚期很常见，但在非透析 CKD 中的频率尚不清楚。本研究旨在评估在参考肾病门诊就诊的非透析 CKD 患者（2 至 4 期）中 RLS 的频率。
110 名定期在肾病诊所就诊的患者自行使用遵循国际 RLS 研究组诊断标准的标准化问卷进行评估。该系列包括 69 名男性和 41 名女性，年龄 68±13.2 岁，平均血清肌酐为 1.7±0.8mg/dL。随后，根据问卷结果将被归类为可能 RLS 的患者进行系统的神经检查。通过踝臂指数（ABI）评估外周动脉疾病的存在。
根据问卷结果，可能 RLS 的频率为 21%（男性为 17%，女性为 27%）。然而，经过彻底的神经检查，仅确诊 5 例 RLS。因此，总的明确 RLS 频率为 4.5%（与一般人群的患病率相当），且在女性中更高（9.7%比 0.2%）。在其余病例中，症状是由于与其他疾病相关的腿部不适。在年龄、ABI、糖尿病和其他合并症方面，可能和不可能 RLS 的患者没有显著差异，除了三环类抗抑郁药的处方，这在可能的 RLS 组中更为常见（17%比 2%）。与问卷分类为可能 RLS 但神经检查后未确诊的患者相比，明确 RLS 患者的肾功能更好。
尽管 RLS 可能是 CKD 的早期表现，但它的患病率似乎与一般人群相似。经过专家检查，RLS 的确诊率大幅下降，这引发了一个问题，即在 RLS 队列的研究中，CKD 是否具有潜在的因果关系，还是与腿部不适的其他原因相关的混杂因素。
