HD and PD showed similar RLS prevalence but divergent sleep disturbance patterns, with distinct risk factor profiles suggesting dialysis-specific mechanisms differentially influence RLS pathophysiology and β2-microglobulin emerging as a universal risk factor.
Key Findings
Results
RLS prevalence was comparable between hemodialysis and peritoneal dialysis patients after propensity score matching.
After 1:1 propensity score matching, RLS prevalence was 39.28% in HD vs. 40.00% in PD (p = 1.0000).
Original unmatched cohort included 173 HD and 223 PD patients enrolled from April to October 2024.
Matched groups consisted of 140 HD and 140 PD patients.
RLS was diagnosed using IRLSSG 2014 criteria.
Propensity score matching was performed on age, sex, education, dialysis vintage, smoking, alcohol consumption, and comorbidities.
Results
Sleep disturbance was significantly more prevalent among PD patients with RLS compared to HD patients with RLS.
Sleep disturbance prevalence among RLS patients: 73.2% in PD vs. 50.9% in HD (p = 0.022).
Sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI ≥ 11 indicating clinically significant sleep disturbance).
Despite similar RLS prevalence, the two modalities showed divergent sleep disturbance patterns.
Results
HD patients showed a numerical trend toward more severe RLS compared to PD patients, though this did not reach statistical significance.
Severe RLS was present in 32.73% of HD patients vs. 19.64% of PD patients (p = 0.754).
The difference in RLS severity distribution between modalities was not statistically significant.
This trend suggests possible modality-specific influences on RLS severity despite similar prevalence rates.
Results
Elevated β2-microglobulin was identified as a shared independent risk factor for RLS in both dialysis modalities with comparable effect sizes.
β2-microglobulin association with RLS showed no significant interaction by dialysis modality (P_interaction = 0.335).
This finding supports β2-microglobulin as a universal risk factor regardless of dialysis modality.
The shared risk factor profile supports unified, risk factor-based screening strategies across dialysis populations.
Results
Lower hemoglobin and elevated eosinophil counts were modality-specific risk factors for RLS confirmed by formal interaction testing in PD patients.
Lower hemoglobin and elevated eosinophil counts were confirmed as PD-specific RLS risk factors by formal interaction testing.
Associations with age (HD) and alcohol consumption (PD) showed only borderline effect modification.
The overall RLS prevalence in the ESRD dialysis population was high, with approximately 39-40% of matched patients affected.
396 ESRD patients were initially enrolled (173 HD, 223 PD) from April to October 2024.
The study characterized RLS as 'highly prevalent among end-stage renal disease (ESRD) patients undergoing dialysis, causing significant sleep disruption.'
Both matched groups showed nearly identical RLS prevalence rates of approximately 39-40%.
What This Means
This research studied a common but underrecognized problem called restless legs syndrome (RLS) — an uncomfortable urge to move the legs, especially at night — in people with kidney failure who receive dialysis. The study compared two types of dialysis: hemodialysis (HD), where blood is filtered through a machine usually three times per week, and peritoneal dialysis (PD), where the abdomen is used for filtering and is typically done daily at home. Nearly 400 patients were enrolled and carefully matched to ensure fair comparisons between the two groups.
The study found that about 39-40% of dialysis patients in both groups had RLS, meaning the type of dialysis did not appear to affect how often RLS occurred. However, despite similar rates of RLS, patients on peritoneal dialysis with RLS were significantly more likely to experience clinically meaningful sleep disturbances (73% vs. 51%), and hemodialysis patients showed a trend toward more severe RLS symptoms. The two modalities also had somewhat different risk factors: low hemoglobin and high eosinophil (a type of immune cell) levels were specifically linked to RLS in PD patients, while one protein called β2-microglobulin was a risk factor in both groups equally.
This research suggests that while the choice of dialysis modality may not change how likely a patient is to develop RLS, it may influence how severely RLS affects sleep and which biological factors drive the condition. The finding that β2-microglobulin is a shared risk factor across both dialysis types is particularly noteworthy, as it could point toward a common biological mechanism and support routine screening for this protein in all dialysis patients. Better understanding these risk factors could help clinicians identify dialysis patients at highest risk of RLS and sleep problems and potentially tailor treatment strategies accordingly.
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Hu N, Yuan T, Teng L, Xu C, Zhang W, Chang W. (2026). Restless legs syndrome in hemodialysis and peritoneal dialysis: a propensity score-matched comparison.. Frontiers in neurology. https://doi.org/10.3389/fneur.2026.1895986