*2.2.2 Restless leg syndrome (RLS)*

It was described in 1944 by K. A. Ekbom and is frequently seen in CKD patients particularly women with crawling leg sensation in leg and a compulsive need to move the limbs, usually leg. It affects 6.6–62% of patients on long-term dialysis [8].

Etiopathogenesis:

It can be familial in about 50% of patients, other risk factors include iron deficiency or iron transport into the CNS, which led to defects in iron homeostasis and downregulation of striatal dopamine receptors.

Management includes:


Drugs: use of alpha2-delta calcium channel ligands such as gabapentin, pregabalin and dopamine agonist like pramipexole 0.125–0.5 mg at night are used, the mechanism of how they act is not known, and opioids have been used with some success.

Optimising dialysis with increased duration and frequency has been associated with a decreased incidence of RLS in FREEDOM study [9]. Middle molecules like alpha1 microglobulin have been linked to recurrence of restless leg syndrome in patient undergoing hemodialysis in small studies, however, more data are needed to reach into conclusion.

RLS improves in most of patients after kidney transplantation.
