Restless Legs Syndrome and Mortality in Kidney Transplant Recipients

Miklos Zsolt Molnar, Andras Szentkiralyi, Anett Lindner, Maria Eszter Czira, Lilla Szeifert, Agnes Zsofia Kovacs, Katalin Fornadi, Andras Szabo, Laszlo Rosivall, Istvan Mucsi, Marta Novak

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Background: Previous studies showed an association between the presence of restless legs syndrome (RLS) and mortality in patients on dialysis therapy. An association between RLS and cardiovascular risk also was reported in the general population. However, no prospective study to date assessed the association between the presence of RLS and mortality in kidney transplant recipients. In a prospective cohort study (Transplantation and Quality of Life-Hungary Study), we tested the hypothesis that the presence of RLS predicts mortality in transplant recipients. Study Design: Prospective cohort study was performed. Settings & Participants: 804 kidney transplant recipients followed up at a single outpatient transplant center were enrolled in the study. Sociodemographic parameters, laboratory data, and medical history were collected at baseline. Data for 4-year outcomes were collected prospectively from patient charts. Predictor: Presence of RLS assessed using the RLS Questionnaire. Outcome & Measurements: We defined 3 primary outcomes: mortality with functioning graft, return to dialysis therapy, and the combined outcome of these 2. Results: Mean age was 49 ± 13 years, estimated glomerular filtration rate was 49 ± 19 mL/min/1.73 m2, and median time after transplantation was 54 months. During the 4 years, 97 patients died and 63 patients returned to dialysis therapy. Mortality at 4 years was significantly greater in patients who had RLS at baseline: univariate hazard ratio for the presence of RLS was 2.53 (95% confidence interval, 1.31 to 4.87). In multivariate Cox proportional hazard analysis, the presence of RLS significantly predicted mortality (hazard ratio, 2.02; 95% confidence interval, 1.03 to 3.95) after adjustment for several covariables. Limitations: The RLS Questionnaire was not validated in transplant recipients. We lacked information for key variables, including HLA mismatch, panel reactive antibodies, cold ischemic time, acute rejection episodes, viral infections, smoking status, and dyslipidemia. Conclusions: RLS, a potentially treatable disease, is a significant risk factor for mortality in kidney transplant recipients.

Original languageEnglish
Pages (from-to)813-820
Number of pages8
JournalAmerican Journal of Kidney Diseases
Issue number5
Publication statusPublished - Nov 1 2007



  • Restless legs syndrome
  • kidney transplantation
  • mortality
  • transplant outcomes

ASJC Scopus subject areas

  • Nephrology

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