Li Jing, Zhang Tao, Shao Qingmiao
Department of Transplantation, The First Central Hospital of Tianjin.
Department of Nephrology, The First Affiliated Hospital of Tianjin Chinese Medical University.
Neuropsychiatr Dis Treat. 2017 Jun 16;13:1569-1574. doi: 10.2147/NDT.S137478. eCollection 2017.
Previous studies have revealed that restless legs syndrome (RLS) not only is frequently prevalent in dialysis patients but also increases the risk of death in dialysis patients, especially in hemodialysis (HD) patients. However, inconsistent results also still exist, having attracted confusion and discussion. Owing to mixed and inconclusive results, we conducted to perform the comprehensive meta-analysis to evaluate the potential prognostic value of RLS in HD patients.
We conducted a systematic literature search using electronic databases (PubMed, Ovid, Embase and Web of Science) to identify relevant studies reporting on all-cause mortality and cardiovascular (CV) events in HD patients suffering from RLS. We searched the literature published up to December 5, 2016, or earlier. We used both fixed- and random-effects models to calculate the overall effect estimate. An >50% indicates at least moderate statistical heterogeneity. A sensitivity analysis and subgroup analysis were performed to find the origin of heterogeneity.
A total of four studies including 1,839 patients found that there was no significant association between RLS and all-cause mortality (hazard ratio [HR]: 1.649; 95% confidence interval [CI]: 0.778-3.496) and CV events (HR: 0.863; 95% CI: 0.600-1.127) in HD patients. Heterogeneity among the studies was observed for all-cause mortality (=80.7%, =0.001).
Our meta-analysis suggests that there was no significant effect of RLS on all-cause mortality and CV events in HD patients. Therefore, large-scale and well-designed studies are needed to validate the association between RLS and the risk of death in HD patients.
既往研究表明，不安腿综合征（RLS）不仅在透析患者中普遍存在，还会增加透析患者的死亡风险，尤其是血液透析（HD）患者。然而，仍存在不一致的结果，引发了困惑和讨论。由于结果混杂且无定论，我们进行了全面的荟萃分析，以评估RLS在HD患者中的潜在预后价值。
我们使用电子数据库（PubMed、Ovid、Embase和Web of Science）进行了系统的文献检索，以确定有关RLS的HD患者全因死亡率和心血管（CV）事件的相关研究。我们检索了截至2016年12月5日或更早发表的文献。我们使用固定效应模型和随机效应模型来计算总体效应估计值。I²>50%表示至少存在中度统计学异质性。进行了敏感性分析和亚组分析以找出异质性的来源。
共有四项研究纳入1839例患者，发现HD患者中RLS与全因死亡率（风险比[HR]：1.649；95%置信区间[CI]：0.778 - 3.496）和CV事件（HR：0.863；95% CI：0.600 - 1.127）之间无显著关联。在全因死亡率方面观察到研究间存在异质性（I² = 80.7%，P = 0.001）。
我们的荟萃分析表明，RLS对HD患者的全因死亡率和CV事件无显著影响。因此，需要大规模、设计良好的研究来验证RLS与HD患者死亡风险之间的关联。
