Hemodialysis 101 | Restless Leg Syndrome: "Restless Nights, Unsettled Legs!"

Some kidney patients have reported, "At night, I experience strange and uncomfortable sensations in my legs. I often have to get up and move around or keep rubbing my legs to relieve the discomfort. During the day, the symptoms are not noticeable, but they occur daily and are very distressing."

Is it just the cold weather, old cold legs, or rheumatism? Kidney patients, take note! If treatment doesn't alleviate these symptoms, you might be suffering from Restless Leg Syndrome (RLS).

1. What is Restless Leg Syndrome?

Restless Leg Syndrome (RLS) is a central nervous system movement disorder characterized by an uncomfortable sensation in the legs that compels the patient to move their limbs.

2. Clinical Manifestations:

RLS primarily causes discomfort in the deep muscles of the legs, such as numbness, swelling, tightness, and itching. Patients describe sensations like "crawling insects," "needle pricks," and "burning pain." These symptoms often appear or worsen at night or during rest, leading to sleep disturbances and poor sleep quality. This condition is often accompanied by anxiety, depression, and insomnia.

80% to 90% of patients experience periodic limb movements during sleep. Repetitive, stereotypical leg movements can wake the patient, forcing them to kick their legs, move joints, or massage their legs. In severe cases, patients need to walk constantly to relieve symptoms.

RLS is frequently misdiagnosed as arthritis, peripheral neuropathy, or insufficient blood supply to the legs, causing delays in diagnosis and treatment.

3. Causes of RLS:

RLS can be primary or secondary. Primary RLS is usually the result of genetic and environmental factors, while secondary RLS can be caused by multiple factors, including maintenance hemodialysis (MHD), Parkinson's disease, peripheral neuropathy, and end-stage renal disease.

For MHD patients with RLS, studies have shown a correlation with anemia, lower serum ferritin levels, and diabetic nephropathy.

4. Diagnosis

According to the diagnostic criteria established by the International Restless Legs Syndrome Study Group (IRLSSG):

1. Patients experience an electrical shock sensation, pain, crawling feeling, twitching, or other indescribable discomfort in the deep parts of both legs.

2. There is a desire to move the limbs, with relief upon appropriate movement/exercise.

3. Symptoms appear or worsen at rest/inactivity.

4. Symptoms are more severe and frequent at night.

5. Symptoms fit the above criteria, excluding muscle cramps, leg shaking, peripheral neuropathy, Parkinson's disease, arthritis, etc.

Patients meeting these five criteria recommended by the IRLSSG can be diagnosed with RLS.

Other Risks:

Beyond physical discomfort, RLS poses additional risks:

· For chronic kidney disease (CKD) patients, RLS significantly increases the incidence and mortality risk of cardiovascular disease. Patients should closely monitor for potential new cardiovascular diseases.

· Diabetic nephropathy patients are at a much higher risk of developing RLS. Some studies suggest that a history of diabetes is a risk factor for both CKD and RLS.

· RLS impairs sleep quality in MHD patients, potentially increasing the risk of sedative and hypnotic use. Lack of sleep leads to fatigue, which is positively correlated with the severity of RLS, creating a vicious cycle.

Aerobic Exercise Benefits

Currently, there is no specific treatment for RLS. Clinical treatment focuses on symptom relief, including both medication and non-medication approaches. Patients should consult specialists for specific treatment plans.

Additionally, engaging in aerobic exercise for more than half an hour three times a week can significantly alleviate RLS symptoms in CKD patients.

Studies have found that compared to placebo, exercise training (46% reduction) and low-dose oral dopamine agonist treatment (54% reduction) are equally effective in improving RLS symptoms.

Exercise not only alleviates symptoms but also helps prevent muscle atrophy, promotes muscle strength recovery, restores normal work and life, reduces depression scores, and improves quality of life.

Although RLS does not pose a life-threatening risk, it severely impacts patients' quality of life. Some patients' symptoms can diminish or disappear for years, but most symptoms persist for life, manageable through treatment.

We hope this issue helps kidney patients understand RLS and seek timely diagnosis and treatment to reduce its impact.

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References:

1. Wu Huilan, et al. Analysis of Factors Related to Restless Legs Syndrome in Maintenance Hemodialysis Patients. Modern Medical Health, 2023, 39(23), 4018-4022+4027.

2. Yin Sujuan, et al. Study on the Risk Factors and TCM Characteristics of Restless Legs Syndrome in Maintenance Hemodialysis Patients. Tianjin Journal of Traditional Chinese Medicine, 2023, 40(09), 1106-1111.

3. Huang Jian, et al. Analysis of Influencing Factors and Clinical Study of Aerobic Exercise Improvement on Restless Legs Syndrome in Maintenance Hemodialysis Patients. Modern Biomedical Progress, 2023, 23(11), 2053-2057.

4. Li Amin. Mechanism and Intervention Study of Restless Legs Syndrome in Maintenance Hemodialysis Patients. Chinese Journal of Integrated Traditional and Western Nephrology, 2022, 23(12), 1126-1128.

5. Zhou Hao. Research on the Treatment of End-Stage Renal Disease Combined with Restless Legs Syndrome. Medical Information, 2022, 35(13), 74-77.

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