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Restless legs syndrome in children with chronic kidney disease

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Abstract

Background

Restless legs syndrome (RLS) is considerably more common among adults with chronic kidney disease (CKD) than in the general population and is associated with increased morbidity and mortality. There is limited information on RLS in children with CKD. Failure to account for conditions that might mimic RLS can lead to overdiagnosis of this syndrome.

Methods

In a prospective, cross-sectional study, RLS prevalence was compared between pediatric CKD patients and healthy children. RLS was assessed via a questionnaire that included exclusion of mimics. Sleep characteristics and health-related quality of life (HRQoL) were also assessed.

Results

Restless legs syndrome was more prevalent in CKD patients (n = 124) than in 85 normal children (15.3 vs. 5.9 %; p = 0.04). There was no significant association between RLS and CKD stage, CKD etiology, CKD duration, and dialysis or transplant status. Children with RLS were more likely to rate their sleep quality as fairly bad or very bad (41.2 vs. 8.8 %; p = 0.003) and report using sleep medications (42.1 vs. 14.7 %; p = 0.01). RLS was associated with lower HRQoL by parent report (p = 0.03). Only five of the 19 patients (26.3 %) with CKD and RLS had discussed RLS symptoms with a healthcare provider, and only one of these patients had been diagnosed with RLS prior to this study.

Conclusions

The prevalence of RLS is increased in children with CKD and appears to be underdiagnosed. Systematic screening for RLS and sleep problems would therefore appear to be warranted in children with CKD.

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References

  1. Merlino G, Lorenzut S, Gigli GL, Romano G, Montanaro D, Moro A, Valente M (2010) A case–control study on restless legs syndrome in nondialyzed patients with chronic renal failure. Mov Disord 25:1019–1025

    Article  PubMed  Google Scholar 

  2. Gigli GL, Adorati M, Dolso P, Piani A, Valente M, Brotini S, Budai R (2004) Restless legs syndrome in end-stage renal disease. Sleep Med 5:309–315

    Article  PubMed  Google Scholar 

  3. Unruh ML, Levey AS, D'Ambrosio C, Fink NE, Powe NR, Meyer KB (2004) Restless legs symptoms among incident dialysis patients: association with lower quality of life and shorter survival. Am J Kidney Dis 43:900–909

    Article  PubMed  Google Scholar 

  4. La Manna G, Pizza F, Persici E, Baraldi O, Comai G, Cappuccilli ML, Centofanti F, Carretta E, Plazzi G, Coli L, Montagna P, Stefoni S (2011) Restless legs syndrome enhances cardiovascular risk and mortality in patients with end-stage kidney disease undergoing long-term haemodialysis treatment. Nephrol Dial Transplant 26:1976–1983

    Article  PubMed  Google Scholar 

  5. Molnar MZ, Novak M, Ambrus C, Szeifert L, Kovacs A, Pap J, Remport A, Mucsi I (2005) Restless legs syndrome in patients after renal transplantation. Am J Kidney Dis 45:388–396

    Article  PubMed  Google Scholar 

  6. Davis ID, Baron J, O'Riordan MA, Rosen CL (2005) Sleep disturbances in pediatric dialysis patients. Pediatr Nephrol 20:69–75

    Article  PubMed  Google Scholar 

  7. Applebee GA, Guillot AP, Schuman CC, Teddy S, Attarian HP (2009) Restless legs syndrome in pediatric patients with chronic kidney disease. Pediatr Nephrol 24:545–548

    Article  PubMed  Google Scholar 

  8. Davis ID, Greenbaum LA, Gipson D, Wu LL, Sinha R, Matsuda-Abedini M, Emancipator JL, Lane JC, Hodgkins K, Nailescu C, Barletta GM, Arora S, Mahan JD, Rosen CL (2012) Prevalence of sleep disturbances in children and adolescents with chronic kidney disease. Pediatr Nephrol 27:451–459

    Article  PubMed  Google Scholar 

  9. Sinha R, Davis ID, Matsuda-Abedini M (2009) Sleep disturbances in children and adolescents with non-dialysis-dependent chronic kidney disease. Arch Pediatr Adolesc Med 163:850–855

    Article  PubMed  Google Scholar 

  10. Allen RP, Picchietti D, Hening WA, Trenkwalder C, Walters AS, Montplaisi J (2003) Restless legs syndrome: diagnostic criteria, special considerations, and epidemiology. A report from the restless legs syndrome diagnosis and epidemiology workshop at the National Institutes of Health. Sleep Med 4:101–119

    Article  PubMed  Google Scholar 

  11. Hening WA, Allen RP, Washburn M, Lesage SR, Earley CJ (2009) The four diagnostic criteria for restless legs syndrome are unable to exclude confounding conditions ("mimics"). Sleep Med 10:976–981

    Article  PubMed  Google Scholar 

  12. Ogden CL, Flegal KM (2010) Changes in terminology for childhood overweight and obesity. Natl Health Stat Report 25:1-5.

    Google Scholar 

  13. National Kidney Foundation (2002) K/DOQI clinical practice guidelines for chronic kidney disease: evaluation, classification, and stratification. Am J Kidney Dis 39:S1–266.

    Google Scholar 

  14. Schwartz GJ, Brion LP, Spitzer A (1987) The use of plasma creatinine concentration for estimating glomerular filtration rate in infants, children, and adolescents. Pediatr Clin North Am 34:571–590

    PubMed  CAS  Google Scholar 

  15. Allen RP, Burchell BJ, MacDonald B, Hening WA, Earley CJ (2009) Validation of the self-completed Cambridge-Hopkins questionnaire (CH-RLSq) for ascertainment of restless legs syndrome (RLS) in a population survey. Sleep Med 10:1097–1100

    Article  PubMed  Google Scholar 

  16. Popat RA, Van Den Eeden SK, Tanner CM, Kushida CA, Rama AN, Black JE, Bernstein A, Kasten M, Chade A, Leimpeter A, Cassidy J, McGuire V, Nelson LM (2010) Reliability and validity of two self-administered questionnaires for screening restless legs syndrome in population-based studies. Sleep Med 11:154–160

    Article  PubMed  Google Scholar 

  17. Picchietti D, Allen RP, Walters AS, Davidson JE, Myers A, Ferini-Strambi L (2007) Restless legs syndrome: prevalence and impact in children and adolescents–the Peds REST study. Pediatrics 120:253–266

    Article  PubMed  Google Scholar 

  18. Drake C, Nickel C, Burduvali E, Roth T, Jefferson C, Pietro B (2003) The pediatric daytime sleepiness scale (PDSS): sleep habits and school outcomes in middle-school children. Sleep 26:455–458

    PubMed  Google Scholar 

  19. Varni JW, Seid M, Kurtin PS (2001) PedsQL 4.0: reliability and validity of the Pediatric Quality of Life Inventory version 4.0 generic core scales in healthy and patient populations. Med Care 39:800–812

    Article  PubMed  CAS  Google Scholar 

  20. Warady BA, Chadha V (2007) Chronic kidney disease in children: the global perspective. Pediatr Nephrol 22:1999–2009

    Article  PubMed  Google Scholar 

  21. Yeh P, Walters AS, Tsuang JW (2012) Restless legs syndrome: a comprehensive overview on its epidemiology, risk factors, and treatment. Sleep Breath 16:987–1007

    Article  PubMed  Google Scholar 

  22. Kutner NG, Bliwise DL (2002) Restless legs complaint in African-American and Caucasian hemodialysis patients. Sleep Med 3:497–500

    Article  PubMed  Google Scholar 

  23. Lee HB, Hening WA, Allen RP, Earley CJ, Eaton WW, Lyketsos CG (2006) Race and restless legs syndrome symptoms in an adult community sample in east Baltimore. Sleep Med 7:642–645

    Article  PubMed  Google Scholar 

  24. Winkelmann J, Wetter TC, Collado-Seidel V, Gasser T, Dichgans M, Yassouridis A, Trenkwalder C (2000) Clinical characteristics and frequency of the hereditary restless legs syndrome in a population of 300 patients. Sleep 23:597–602

    PubMed  CAS  Google Scholar 

  25. Yilmaz K, Kilincaslan A, Aydin N, Kor D (2011) Prevalence and correlates of restless legs syndrome in adolescents. Dev Med Child Neurol 53:40–47

    Article  PubMed  Google Scholar 

  26. Takaki J, Nishi T, Nangaku M, Shimoyama H, Inada T, Matsuyama N, Kumano H, Kuboki T (2003) Clinical and psychological aspects of restless legs syndrome in uremic patients on hemodialysis. Am J Kidney Dis 41:833–839

    Article  PubMed  Google Scholar 

  27. Novak M, Mendelssohn D, Shapiro CM, Mucsi I (2006) Diagnosis and management of sleep apnea syndrome and restless legs syndrome in dialysis patients. Semin Dial 19:210–216

    Article  PubMed  Google Scholar 

  28. Mucsi I, Molnar MZ, Ambrus C, Szeifert L, Kovacs AZ, Zoller R, Barotfi S, Remport A, Novak M (2005) Restless legs syndrome, insomnia and quality of life in patients on maintenance dialysis. Nephrol Dial Transplant 20:571–577

    Article  PubMed  Google Scholar 

  29. Winkelmann J, Stautner A, Samtleben W, Trenkwalder C (2002) Long-term course of restless legs syndrome in dialysis patients after kidney transplantation. Mov Disord 17:1072–1076

    Article  PubMed  Google Scholar 

  30. Aritake-Okada S, Nakao T, Komada Y, Asaoka S, Sakuta K, Esaki S, Nomura T, Nakashima K, Matsuura M, Inoue Y (2011) Prevalence and clinical characteristics of restless legs syndrome in chronic kidney disease patients. Sleep Med 12:1031–1033

    Article  PubMed  Google Scholar 

  31. O'Brien LM (2009) The neurocognitive effects of sleep disruption in children and adolescents. Child Adolesc Psychiatr Clin N Am 18:813–823

    Article  PubMed  Google Scholar 

  32. Hart CN, Cairns A, Jelalian E (2011) Sleep and obesity in children and adolescents. Pediatr Clin North Am 58:715–733

    Article  PubMed  Google Scholar 

  33. Ayas NT, White DP, Al-Delaimy WK, Manson JE, Stampfer MJ, Speizer FE, Patel S, Hu FB (2003) A prospective study of self-reported sleep duration and incident diabetes in women. Diabetes Care 26:380–384

    Article  PubMed  Google Scholar 

  34. Ayas NT, White DP, Manson JE, Stampfer MJ, Speizer FE, Malhotra A, Hu FB (2003) A prospective study of sleep duration and coronary heart disease in women. Arch Intern Med 163:205–209

    Article  PubMed  Google Scholar 

  35. Earley CJ, Silber MH (2010) Restless legs syndrome: understanding its consequences and the need for better treatment. Sleep Med 11:807–815

    Article  PubMed  Google Scholar 

  36. Hooper SR, Gerson AC, Butler RW, Gipson DS, Mendley SR, Lande MB, Shinnar S, Wentz A, Matheson M, Cox C, Furth SL, Warady BA (2011) Neurocognitive functioning of children and adolescents with mild-to-moderate chronic kidney disease. Clin J Am Soc Nephrol 6:1824–1830

    Article  PubMed  Google Scholar 

  37. Roumelioti ME, Wentz A, Schneider MF, Gerson AC, Hooper S, Benfield M, Warady BA, Furth SL, Unruh ML (2010) Sleep and fatigue symptoms in children and adolescents with CKD: a cross-sectional analysis from the chronic kidney disease in children (CKiD) study. Am J Kidney Dis 55:269–280

    Article  PubMed  Google Scholar 

  38. Hening WA (2004) Restless legs syndrome: the most common and least diagnosed sleep disorder. Sleep Med 5:429–430

    Article  PubMed  CAS  Google Scholar 

  39. Picchietti MA, Picchietti DL (2008) Restless legs syndrome and periodic limb movement disorder in children and adolescents. Semin Pediatr Neurol 15:91–99

    Article  PubMed  Google Scholar 

  40. Hening WA, Allen RP, Earley CJ, Picchietti DL, Silber MH (2004) An update on the dopaminergic treatment of restless legs syndrome and periodic limb movement disorder. Sleep 27:560–583

    PubMed  Google Scholar 

  41. Picchietti DL, Stevens HE (2008) Early manifestations of restless legs syndrome in childhood and adolescence. Sleep Med 9:770–781

    Article  PubMed  Google Scholar 

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Acknowledgments

We would like to thank Ms. Margaret Kamel for her work as a research coordinator on this study and Dr. Sandra Amaral for reviewing the manuscript.

Financial disclosure

This research was supported by a Friends Grant from Children’s Healthcare of Atlanta. Donald L. Bliwise is a Consultant for Ferring Pharmaceuticals and New England Research Institute. None of the other authors have any disclosures.

Author information

Authors and Affiliations

  1. Division of Pediatric Nephrology, University of Kansas Medical Center, Kansas City, KS, USA

    Sandeep K. Riar

  2. Division of Pulmonology, Allergy, Cystic Fibrosis and Sleep Medicine, Emory University and Children’s Healthcare of Atlanta, Atlanta, GA, USA

    Roberta M. Leu

  3. Division of Pediatric Nephrology, Emory University and Children’s Healthcare of Atlanta, Atlanta, GA, USA

    Taieshia C. Turner-Green

  4. Department of Neurology, Emory University, Atlanta, GA, USA

    David B. Rye

  5. Department of Pediatrics, Emory University and Children’s Healthcare of Atlanta, Atlanta, GA, USA

    Salathiel R. Kendrick-Allwood

  6. Department of Pediatrics, Emory University, Atlanta, GA, USA

    Courtney McCracken

  7. Department of Neurology, Emory University, Atlanta, GA, USA

    Donald L. Bliwise

  8. Division of Pediatric Nephrology, Emory University and Children’s Healthcare of Atlanta, Atlanta, GA, USA

    Larry A. Greenbaum

  9. Division of Pediatric Nephrology, Emory University, 2015 Uppergate Drive, NE, Atlanta, GA, 30322, USA

    Larry A. Greenbaum

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  1. Sandeep K. Riar
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  2. Roberta M. Leu
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  3. Taieshia C. Turner-Green
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  5. Salathiel R. Kendrick-Allwood
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  7. Donald L. Bliwise
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  8. Larry A. Greenbaum
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Corresponding author

Correspondence to Larry A. Greenbaum.

Appendices

Appendix 1a: RLS questionnaire for age 8–12 years

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Appendix 1b: RLS questionnaire for age 13–18 years

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Riar, S.K., Leu, R.M., Turner-Green, T.C. et al. Restless legs syndrome in children with chronic kidney disease. Pediatr Nephrol 28, 773–795 (2013). https://doi.org/10.1007/s00467-013-2408-9

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  • DOI: https://doi.org/10.1007/s00467-013-2408-9

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