The influence of hemoperfusion on restless legs syndrome and sleep quality in elderly maintenance hemodialysis patients / 中华老年医学杂志

ABSTRACT

ObjectiveTo explore the prevalence and influencing factors of restless legs syndrome (RLS) in elderly maintenance hemodialysis (MHD) patients, to analyze the relationship between RLS and sleep quality, and to observe the efficacy and safety of hemoperfusion in improving RLS and sleep quality in elderly MHD patients with RLS. MethodsA total of 118 cases with maintenance bemodialysis were involved in this study. The RLS was diagnosed according to the criteria of the International Restless Legs Syndrome Study Group (IRLSSG). The subjects' quality of sleep was assessed by the Pittsburgh Sleep Quality Index (PSQI). The elderly MHD patients with RLS received hemoperfusion once a week for 3 months. The clinical and biochemical indexes were collected including age, gender, duration of hemodialysis, pre-dialysis blood concentrations of creatinine, hemoglobin, parathyroid hormone, β2-microglobulin, etc. T test, X2 test and binary logistic regression analysis were performed. ResultsRLS prevalence was found in 26.27% (11 men, 20 women, the ratio was 0. 55 1) of 118 elderly MHD patients. The duration of hemodialysis,sex ratio (female/male), the level of serum phosphorus, β2-microglobulin and parathyroid hormone in elderly MHD patients with RLS were significantly higher than those in elderly MHD patients withoutRLS (t=2. 332,X2=15. 343,t=4. 784,13. 124,10. 900;all P<0. 05). And there were no significant differences in age, dry weight, material of dialyzer membrane, and levels of serum creatinine, urea nitrogen, hemoglobin, hematocrit, calcium, ferritin and transferrin saturation between patients with RLS and without RLS(t=0. 341,0. 008, 1. 055,0. 051,0. 899,0. 912,0. 601,0. 192,0. 200,1. 094;all P>0.05). Logistic regression analysis revealed that serum parathyroid hormone and β2-microglobulinwere the important risk factors for RLS in elderly MHD patients. PSQI was higher in RLS group than in non-RLS group[(10. 7±2.7) vs. (4.9±2.5), t=10. 948,P=0. 000] . The manifestations of poor sleep were poor indexes of subjective sleep quality, sleep duration, habitual sleep efficiency and daytime dysfunction in MHD patients with RLS. And the RLS severity was correlated with PSQI (r=0. 839,P<0. 05). After the treatment with hemoperfusion, the level of serum phosphorus, serum parathyroid hormone, serum β2-microglobulin, RLS severity score and PSQI were significantly decreased in RLS patients compared with pre-hemoperfusion. The vital sign of RLS patients were stable during hemoperfusion, and there were no adverse events after the treatment with hemoperfusion. ConclusionsThe prevalence of RLS is high, and poor sleep quality is found in elderly MHD patients with RLS. Serum parathyroid hormone and β2-microglobulin are the important risk factors for RLS in elderly MHD patients. Hemoperfusion can effectively improve the RLS and sleep quality and is well tolerated.