Restless Leg Syndrome, Insomnia, and Depression in Hemodialysis Patients: Three Sides of a Triangle?

Background: Restless leg syndrome (RLS) is a sensorimotor neurological disorder with high prevalence among patients with endstage renal disease (ESRD) and is associated with sleep and mood disturbances. The current study evaluated the associations between RLS, depression and insomnia in patients undergoing hemodialysis. Methods: The current cross sectional study collected sociodemographic, laboratory data, and medical history of 235 patients undergoing hemodialysis. RLS was assessed by a questionnaire designed by national institutes of health/international RLS study group (IRLSSG), depression by hospital anxiety depression scale (HADS), and insomnia by Pittsburgh sleep quality index (PSQI). Results: The prevalence of RLS in patients undergoing hemodialysis was 23.4%; out of which 43.6% had severe and very severe RLS. Patients with RLS had a positive family history of RLS (P value < 0.001). There was no difference between the demographic and laboratory findings of the patients. In comparison to the patients without RLS, the patients with RLS had a higher prevalence of depression (63.6% vs. 42.2%, P value = 0.005), and more severe insomnia score (mean PSQI-score = 8.2 ± 4.9 vs. 6.2 ± 4 (P value = 0.009). The PSQI score were correlated with HADS score (P value < 0.001). In multivariate analysis, the link between RLS and depression depended on insomnia. Conclusions: RLS is prevalent among patients undergoing dialysis and could lead to depression, even in the absence of insomnia. Thus, it seems that appropriate diagnosis and management of RLS would make a difference in quality of life of patients undergoing hemodialysis.