Tadahiro Nishi

Clinical and psychological aspects of restless legs syndrome in uremic patients on hemodialysis

BACKGROUND The pathogenesis of restless legs syndrome (RLS) is still unclear. The purpose of this study is to determine relationships of the presence of RLS in uremic patients regularly undergoing hemodialysis (HD) with demographic, clinical, and psychological factors. METHODS In 490 uremic patients on HD therapy in Japan, RLS was diagnosed based on diagnostic criteria established by the International Restless Legs Syndrome Study Group. Data were compared between patients with and without RLS. RESULTS There were univariately significant (P < 0.05) differences in serum phosphorus levels, anxiety levels determined using the Hospital Anxiety and Depression Scale, and degrees of emotion-oriented and avoidance-oriented coping determined using the Coping Inventory for Stressful Situations. In multivariate analyses, low hemoglobin levels, high serum phosphorus levels, high anxiety levels, and a great degree of emotion-oriented coping were independently related to the presence of RLS in uremic patients on HD therapy, with statistical significance (P < 0.05). CONCLUSION Hyperphosphatemia, anxiety, and a great degree of emotion-oriented coping with stress were independently related to the presence of RLS in uremic patients on HD therapy. The pathogenesis of RLS seems to involve more than one mechanism, which leads to restless legs as the final common pathway. These findings may provide new clues to the pathogenesis of RLS.

Possible variances of blood urea nitrogen, serum potassium and phosphorus levels and interdialytic weight gain accounted for compliance of hemodialysis patients

OBJECTIVES The aim of this study was to assess the possible variances of blood urea nitrogen (BUN), serum potassium (SK) and serum phosphorus (SPO(4)) levels and interdialytic weight gain (IWG) accounted for compliance of uremic patients on hemodialysis (HD). METHODS BUN, SK and SPO(4) levels and IWG of uremic patients (n=310) regularly undergoing three HD sessions per week for more than 1 year in Japan were assessed. Patients suffering from problems influencing dietary intake and those with malnutrition were excluded. The variances accounted for self-efficacy for health-related behavior and avoidance-oriented coping (AOC) with stress were assessed by hierarchical multiple regression analyses. RESULTS BUN and SPO(4) levels were not significantly (P<.05) associated with self-efficacy or AOC. SK levels and IWG were significantly (P<.05) associated with self-efficacy and/or AOC. The variances of SK levels and IWG accounted for self-efficacy and/or AOC, independent of age, sex, duration of HD and facilities, were 1.6% and 5.0%, respectively. CONCLUSIONS Although the variances of SK levels and IWG accounted for self-efficacy and/or AOC were rather small, the significance of their relationships may suggest that intervention for self-efficacy or AOC could improve compliance and reduce SK levels and IWG of uremic patients on HD.