Department of Psychiatry, Sleep Medicine Division, Stanford Health Care, US.
Division of Nephrology and Hypertension, Departments of Medicine, Physiology and Biophysics, University of California, Irvine, Irvine, California, US.
Tremor Other Hyperkinet Mov (N Y). 2023 Mar 29;13:10. doi: 10.5334/tohm.752. eCollection 2023.
The objective of this review is to provide updated information on the epidemiology, correlating factors and treatment of chronic kidney disease associated restless legs syndrome (CKD-A-RLS) in both adult and pediatric population.
We have reviewed the Medline search and Google Scholar search up to May 2022, using key words restless legs syndrome, chronic kidney disease and hemodialysis and kidney transplant. The reviewed articles were studied for epidemiology, correlating factors, as well as pharmacologic and non-pharmacologic treatment options.
Our search revealed 175 articles, 111 were clinical trials or cross- sectional studies and 64 were review articles. All 111 articles were retrieved and studied in detail. Of these, 105 focused on adults and 6 on children. A majority of studies on dialysis patients reported a prevalence between 15-30%, which is notably higher than prevalence of RLS in general population (5-10%). The correlation between presence of CKD-A-RLS with age, gender, abnormalities of hemogram, iron, ferritin, serum lipids, electrolytes and parathyroid hormones were also reviewed. The results were inconsistent and controversial. Limited studies have reported on the treatment of CKD-A-RLS. Non-pharmacological treatment focused on the effect(s) of exercise, acupuncture, massage with different oils and infra-red light whereas, pharmacologic treatment options include the effects of dopaminergic drugs, Alpha2-Delta ligands (gabapentin and pregabalin), vitamins E and C, and intravenous iron infusion.
This updated review showed that RLS is two to three times more common in patients with CKD compared to the general population. More patients with CKD-A-RLS demonstrated increased mortality, increased incidence of cardiovascular accident, depression, insomnia and impaired quality of life than those with CKD without RLS. Dopaminergic drugs such as levodopa, ropinirole, pramipexole and rotigotine as well as calcium channel blockers (gabapentin and pregabalin) are helpful for treatment of RLS. High quality studies with these agents are currently underway and hopefully confirm the efficacy and practicality of using these drugs in CKD-A-RLS. Some studies have shown that aerobic exercise and massage with lavender oil can improve symptoms of CKD-A- RLS suggesting that these measures can be useful as adjunct therapy.
本次综述旨在提供成人和儿科人群中慢性肾脏病相关不宁腿综合征（CKD-A-RLS）的流行病学、相关因素和治疗的最新信息。
我们检索了截至 2022 年 5 月的 Medline 和 Google Scholar，使用关键词不宁腿综合征、慢性肾脏病和血液透析及肾移植。对检索到的文章进行了流行病学、相关因素以及药物和非药物治疗选择的研究。
我们的搜索结果显示有 175 篇文章，其中 111 篇为临床试验或横断面研究，64 篇为综述文章。所有 111 篇文章均被检索并进行了详细研究。其中，105 篇文章关注成人，6 篇文章关注儿童。大多数关于透析患者的研究报告的患病率在 15-30%之间，这明显高于一般人群中 RLS 的患病率（5-10%）。还对 CKD-A-RLS 与年龄、性别、血液异常、铁、铁蛋白、血脂、电解质和甲状旁腺激素之间的相关性进行了回顾。结果不一致且存在争议。有限的研究报告了 CKD-A-RLS 的治疗方法。非药物治疗侧重于运动、针灸、按摩不同的油和红外线的效果，而药物治疗选择包括多巴胺能药物、α2-δ配体（加巴喷丁和普瑞巴林）、维生素 E 和 C 以及静脉铁输注的效果。
本次更新的综述表明，与一般人群相比，CKD 患者的 RLS 发病率高 2-3 倍。与 CKD 无 RLS 的患者相比，CKD-A-RLS 患者的死亡率更高、心血管意外发生率更高、抑郁、失眠和生活质量受损。多巴胺能药物如左旋多巴、罗匹尼罗、普拉克索和罗替戈汀以及钙通道阻滞剂（加巴喷丁和普瑞巴林）有助于治疗 RLS。目前正在进行这些药物的高质量研究，希望能证实这些药物在 CKD-A-RLS 中的疗效和实用性。一些研究表明，有氧运动和薰衣草油按摩可以改善 CKD-A-RLS 的症状，这表明这些措施可以作为辅助治疗方法。
