Sleep Quality and Health-Related Quality of Life in Hemodialysis Patients With and Without Restless Legs Syndrome
Main Article Content
Introduction. Restless legs syndrome (RLS) is a frequent complication in people with chronic kidney disease (CKD), especially in maintenance hemodialysis. Its frequency among hemodialysis patients is far above that of the general population, with estimates spanning widely from 5%-70%. For patients on long-term dialysis, RLS can disrupt sleep and lower quality of life. This study aimed to contrast sleep quality and health-related quality of life (HRQOL) between maintenance hemodialysis patients who have RLS and those who do not. Methods. A cross-sectional design was applied to patients on maintenance hemodialysis. RLS status was established using the diagnostic criteria of the International Restless Legs Syndrome Study Group (IRLSSG). Sleep quality was measured with the Pittsburgh Sleep Quality Index (PSQI) and health-related quality of life with the Kidney Disease Quality of Life-36 (KDQOL-36). Results. Among 61 participants, 31% fulfilled the criteria for RLS. In exploratory unadjusted comparisons, the two groups differed in age, proportion with type 2 diabetes mellitus, and serum potassium. Patients with RLS slept significantly worse, with a median global PSQI score of 9 (IQR 6–10.5) against 4.5 (IQR 2.25–7) in those without RLS (p<0.001). KDQOL-36 scores were likewise significantly lower in the RLS group on the symptom/problem list (73.35 vs 84.27; p=0.011), effects of kidney disease (61.35 vs 74.70; p=0.009), and burden of kidney disease (24.34 vs 41.51; p=0.002). Conclusion. RLS was frequent in maintenance hemodialysis patients. Those with RLS slept worse and reported lower HRQOL across several kidney disease–specific domains than those without it.
Keywords:
Hemodialysis
Restless legs syndrome
Chronic kidney disease
Sleep quality
Quality of life
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32. Chu G, Matricciani L, Russo S, Viecelli AK, Jesudason S, Bennett P, et al. Sleep disturbances in adults with chronic kidney disease: an umbrella review. Journal of nephrology. 2025;10.1007/s40620-02502214-8.
33. Salib M, Memon AN, Gowda AS, Rallabhandi B, Bidika E, Fayyaz H, et al. Dialysis Patients With Restless Leg Syndrome: Can We Relieve Their Suffering? Cureus. 2020; 12(8): e10053.
34. Al krush AH. Prevalence, Severity, and Determinants of Restless Legs Syndrome Among Patients on Maintenance Hemodialysis: A Cross-Sectional Study. Med J Basrah Univ.2025;43(2). doi: 10.33762/mjbu.2025.166506.1329
2. Agarwal A, Anjum F. Hemodialysis. PubMed. Treasure Island (FL): StatPearls Publishing; 2023.
3. Allen RP, Picchietti DL, Garcia-Borreguero D, Ondo WG, Walters AS, Winkelman JW, et al. Restless legs syndrome/Willis–Ekbom disease diagnostic criteria: updated International Restless Legs Syndrome Study Group (IRLSSG) consensus criteria – history, rationale, description, and significance. Sleep Medicine. 2014 Aug;15(8):860–73
4. Manconi M, Garcia-Borreguero D, Schormair B, Videnovic A, Berger K, Ferri R, et al. Restless legs syndrome. Nature Reviews Disease Primers. 2021;7(1):1–18.
5. Liu Y, Du Q, Jiang Y. Prevalence of restless legs syndrome in maintenance hemodialysis patients: A systematic review and meta-analysis. Sleep Medicine. 2023;114:15–23.
6. Aini N, Marta OFD, Mashfufa EW, Setyowati L. Association between Chronic kidney disease and restless leg syndrome (RLS): a systematic review and meta-analysis. Sleep and Biological Rhythms.2024;22(2):227–37.
7. Harahap RH, Muzasti RA, Nasution AT. Fibroblast Growth Factor-23 (FGF-23) in Patients with Regular Hemodialysis: A Risk Factor for Restless Legs Syndrome. Journal of Endocrinology, Tropical Medicine, and Infectiouse Disease (JETROMI). 2020 Aug 28;2(3):133–43.
8. Earley CJ, Connor J, Garcia-Borreguero D, Jenner P, Winkelman J, Zee PC, et al. Altered Brain iron homeostasis and dopaminergic function in Restless Legs Syndrome (Willis–Ekbom Disease). Sleep Medicine. 2014;15(11):1288–301.
9. Didato G, Di Giacomo R, Rosa GJ, Dominese A, de Curtis M, Lanteri P. Restless Legs Syndrome across the Lifespan: Symptoms, Pathophysiology, Management and Daily Life Impact of the Different Patterns of Disease Presentation. International Journal of Environmental Research and Public Health. 2020;17(10):3658.
10. Neves PDMM, Graciolli FG, Oliveira IB, Bridi RA, Moysés RMA, Elias RM. Effect of Mineral and Bone Metabolism on Restless Legs Syndrome in Hemodialysis Patients. Journal of Clinical Sleep Medicine. 2017;13(01):89–94.
11. Garcia-Borreguero D, Cano-Pumarega I. New concepts in the management of restless legs syndrome. BMJ. 2017;104.
12. Natale P, Ruospo M, Saglimbene VM, Palmer SC, Strippoli GF. Interventions for improving sleep quality in people with chronic kidney disease. Cochrane Database of Systematic Reviews. 2019 May 26;
13. Fabbri M, Beracci A, Martoni M, Meneo D, Tonetti L, Natale V. Measuring Subjective Sleep Quality: A Review. International Journal of Environmental Research and Public Health. 2021;18(3):1082.
14. Baiardi S, Mondini S, Alessandro Baldi Antognini, Santoro A, Fabio Cirignotta. Survival of Dialysis Patients with Restless Legs Syndrome: A 15-Year Follow-Up Study. American Journal of Nephrology. 2017;46(3):224–30.
15. Diaz S, Abad K, Patel SR, Unruh ML. Emerging Treatments for Insomnia, Sleep Apnea, and Restless Leg Syndrome Among Dialysis Patients. Seminars in Nephrology. 2021;41(6):526–33.
16. Supriyadi R, Rakhima F, Gondodiputro RS, Darmawan G. Validity and Reliability of the Indonesian Version of Kidney Disease Quality of Life (KDQOL-36) Questionnaire in Hemodialysis Patients at Hasan Sadikin Hospital, Bandung, Indonesia. Acta Med Indones. 2019;51(4):318-323.
17. Evinta R, Nurhusna, Subandi A. Identifikasi hubungan tingkat Restless Legs Syndrome (RLS) dengan kualitas tidur pasien gagal ginjal kronik yang menjalani hemodialisis. Jurnal Ners: Research & Learning in Nursing Science. 2025;9(1):829-839.
18. Zhou X, Liu Y, Zhang X, Wang C, Liu S, Jiang Y. Global prevalence of restless legs syndrome among hemodialysis patients: A systematic review and meta‐analysis. Brain and behavior. 2024;14(1).
19. Zhang L, Ma X, Lin J, Liu W, Wei G, Li Y, et al. Prevalence and Risk Factors of Restless Legs Syndrome in Hemodialysis Patients. Nature and Science of Sleep. 2020;12:19–27.
20. Kim KY, Kim EH, Lee M, Ha J, Jung I, Kim E. Restless leg syndrome and risk of all-cause dementia: a nationwide retrospective cohort study. Alzheimers Res Ther. 2023;15(1):46.
21. Fulda S, Allen RP, Earley C, Högl B, Garcia-Borreguero D, Inoue Y, et al. We need to do better: a systematic review and meta-analysis of diagnostic test accuracy of restless legs syndrome screening instruments. Sleep Medicine Reviews. 2021;101461.
22. Hasheminasab Zaware R, Mahmoodi Meymand MH, Rezaeian M, Mohammadi Kamalabadi N, Mostafavi SA, Abdolkarimi Dawarani MA, et al. Insomnia and Restless Leg Syndrome in Patients Undergoing Chronic Hemodialysis in Rafsanjan Ali Ibn Abitaleb Hospital. Nephro-Urology Monthly. 2016;8(1).
23. Lin XW, Zhang JF, Qiu MY, Ni LY, Yu HL, Kuo SH, et al. Restless legs syndrome in end stage renal disease patients undergoing hemodialysis. BMC Neurology. 2019;19(1).
24. Brzuszek A, Hazara AM, Bhandari S. The prevalence and potential aetiological factors associated with restless legs syndrome in patients with chronic kidney disease: a cross-sectional study. Int Urol Nephrol. 2022; 54(10): 2599-2607
25. Turk A, Ozkurt S, Turgal E, Sahin F. The association between the prevalence of restless leg syndrome, fatigue, and sleep quality in patients undergoing hemodialysis. Saudi Medical Journal. 2018;39(8):792–8.
26. Riar SK, Greenbaum LA, Bliwise DL, Leu RM. Restless Legs Syndrome in Chronic Kidney Disease: Is Iron or Inflammatory Status To Blame? J Clin Sleep Med. 2019;15(11):1629–34.
27. Xu N, Li S, Zhang X, Wang Y, Li X. Restless legs syndrome in end-stage renal disease patients on maintenance hemodialysis: Quality of life and sleep analysis. Advanced neurology. 2023;2(1):210–0.
28. Tufekci A, Kara E. Relation of serum hepcidin levels and restless legs syndrome in chronic hemodialysis patients. Sleep Breath. 2021; 25(2): 897-905
29. Kambampati S, Wasim S, Kukkar V, Awad VM, Malik BH. Restless Leg Syndrome in the Setting of Patients With End-Stage Renal Disease on Hemodialysis: A Literature Review. Cureus. 2020; 12(8): e9965
30. Yaseen M, Jarullah FA, Yaqoob S, Shakeel HA, Maqsood H, Naveed S. Association of quality of life, anxiety, and depression with restless leg syndrome in the hemodialysis patients. BMC Research Notes. 2021;14(1).
31. Yılmaz O, Şengül Y, Şengül HS, Parlakkaya FB, Öztürk A. Investigation of alexithymia and levels of anxiety and depression among patients with restless legs syndrome. Neuropsychiatr Dis Treat. 2018;14:2207–14.
32. Chu G, Matricciani L, Russo S, Viecelli AK, Jesudason S, Bennett P, et al. Sleep disturbances in adults with chronic kidney disease: an umbrella review. Journal of nephrology. 2025;10.1007/s40620-02502214-8.
33. Salib M, Memon AN, Gowda AS, Rallabhandi B, Bidika E, Fayyaz H, et al. Dialysis Patients With Restless Leg Syndrome: Can We Relieve Their Suffering? Cureus. 2020; 12(8): e10053.
34. Al krush AH. Prevalence, Severity, and Determinants of Restless Legs Syndrome Among Patients on Maintenance Hemodialysis: A Cross-Sectional Study. Med J Basrah Univ.2025;43(2). doi: 10.33762/mjbu.2025.166506.1329
