Restless legs syndrome in hemodialysis and peritoneal dialysis: a propensity score-matched comparison.

BACKGROUND

Restless legs syndrome (RLS) is highly prevalent among end-stage renal disease (ESRD) patients undergoing dialysis, causing significant sleep disruption. Whether dialysis modality influences RLS occurrence remains controversial. This study compared RLS prevalence, severity, and sleep outcomes between hemodialysis (HD) and peritoneal dialysis (PD) patients using propensity score matching.

METHODS

From April to October 2024, 396 ESRD patients (173 HD, 223 PD) were enrolled. RLS was diagnosed using IRLSSG 2014 criteria. Sleep quality was assessed using Pittsburgh Sleep Quality Index (PSQI ≥11 indicating clinically significant sleep disturbance). 1:1 propensity score matching was performed on age, sex, education, dialysis vintage, smoking, alcohol consumption, and comorbidities. Matched groups (140 HD, 140 PD) were compared for RLS prevalence, severity, and sleep outcomes.

RESULTS

After matching, RLS prevalence was comparable between HD and PD (39.28% vs. 40.00%, p = 1.0000). However, sleep disturbance was significantly more prevalent among PD patients with RLS (73.2% vs. 50.9%, p = 0.022). HD patients showed a trend toward more severe RLS (32.73% severe vs. 19.64% in PD, p = 0.754). Modality-specific risk factors, confirmed by formal interaction testing, were limited to lower hemoglobin and elevated eosinophil counts in PD patients; associations with age (HD) and alcohol consumption (PD) showed only borderline effect modification. Elevated β2-microglobulin was a shared independent risk factor with comparable effect sizes (P_interaction = 0.335).

CONCLUSION

HD and PD showed similar RLS prevalence but divergent sleep disturbance patterns. Distinct risk factor profiles suggest dialysis-specific mechanisms differentially influence RLS pathophysiology. β2-Microglobulin emerged as a universal risk factor, supporting unified, risk factor-based screening strategies to improve sleep quality in dialysis populations regardless of modality.