Daily home dialysis makes 'restless legs' better

(Press-News.org) For dialysis patients, performing daily dialysis at home can help alleviate sleep problems related to restless legs syndrome (RLS), according to a study appearing in an upcoming issue of the Clinical Journal of the American Society of Nephrology (CJASN). RLS, a common and troublesome problem for dialysis patients, affects hemodialysis patients about four times as often as people in the general population.

These results, from a study by lead author Bertrand L. Jaber, MD (St Elizabeth's Medical Center, Boston) and colleagues, add to the growing list of quality-of-life benefits received from home short daily hemodialysis (SDHD).

The preliminary report was part the FREEDOM study, which is evaluating SDHD as an alternative to dialysis center treatment. In SDHD, patients perform dialysis at home for a few hours, six days per week. "The FREEDOM Study is the largest U.S.-based observational study examining the potential clinical and economic benefits of home SDHD, which has witnessed an uptick in recent years," Jaber explains.

The researchers analyzed data on 235 patients to see how SDHD affected symptoms of RLS. Patients with RLS have abnormal feelings—such as "pins and needles" or crawling sensations—that are relieved by moving the legs. These feelings may lead to sleep problems, such as insomnia and daytime sleepiness. Although the exact cause is unknown, RLS has been linked to increased rates of cardiovascular complications and death.

For the FREEDOM study patients, switching to SDHD led to significant improvement in RLS-related symptoms. "Over 12 months, there was decline in the percentage of patients reporting RLS and in those reporting moderate-to-severe symptoms," says Jaber. The patients also reported lasting improvement in sleep disorders—even after adjustment for the presence of RLS and for use of anti-anxiety and sedative drugs.

Future FREEDOM study results will determine how SDHD affects hospitalization rates and overall non-treatment related costs in dialysis patients.

The study had some important limitations including selection bias—evident by the recruitment of a relatively young (although not necessarily healthier) patient population. The absence of a control group is another important limitation, although the observed improvements in quality-of-life measures persisted beyond four months.

### The FREEDOM study is sponsored and funded by NxStage Medical, Inc. (Lawrence, MA). The following authors are members of the NxStage Scientific Advisory Board that oversees the FREEDOM study: John M. Burkart, MD, Fredric O. Finkelstein, MD; Bertrand L. Jaber, MD, MS; Michael A. Kraus, MD; Brent W. Miller, MD; and Brigitte Schiller, MD.

Study co-authors were Brigitte Schiller, MD (Satellite Healthcare, San Jose, Calif), John M. Burkart, MD (Wake Forest University Medical Center, Winston-Salem, NC), Rachid Daoui, MD (Hortense & Louis Rubin Dialysis Center, Clifton Park, NY), Michael A. Kraus, MD, Isaac Teitelbaum, MD (University of Colorado Hospital, Aurora, CO), Yoojin Lee, MS (Tufts Medical Center, Boston, MA), Brent W. Miller, MD (Washington University School of Medicine, St Louis), Amy W. Williams, MD, (Mayo Clinic College of Medicine), and Fredric O. Finkelstein, MD (Yale University School of Medicine, New Haven, CT).

The article, entitled "Impact of At-home Short Daily Hemodialysis on Restless Legs Symptoms and Sleep Disturbances" (doi 10.2215/CJN.10451110), will appear online at http://cjasn.asnjournals.org/ on March 17, 2011.

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