Medications associated with restless legs syndrome: a case–control study in the US Renal Data System (USRDS)

• End-stage renal disease (ESRD) is associated with restless legs syndrome (RLS).
• Many case studies have suggested certain medications aggravate RLS.
• Antidepressants, antihistamines, neuroleptics, and antiemetics are commonly used in patients with.
• A case–control study of large ESRD database associated medications with RLS diagnosis.
• Medication use in ESRD patients should take risk/benefit ratio into account.

ObjectiveThe objective of this study was to determine the association between the usage of four classes of “at-risk” medications (antidepressants, neuroleptics, antihistamines, and antiemetics with dopamine blockade) and restless legs syndrome (RLS) in dialysis patients within the United States Renal Data System (USRDS).MethodsThis was a case–control design within a national (United States) patient registry of all patients with end-stage renal disease (ESRD) in the USRDS anytime during the period of 1 October 2006 to 31 December 2010, inclusive. A total of 16,165 ESRD patients (3234 cases; 12,931 age-, sex-, and race-matched controls) were studied.ResultsAll four classes of “at-risk” medications see widespread use among patients in the USRDS. All were associated with increased odds of an RLS diagnosis (range of odds ratios, 1.47–2.28; all p < 0.0001) during the period of observation. Results were unchanged when controlling for time on hemodialysis. Usage of more than one class of medication increased the odds for having RLS.ConclusionsESRD patients often receive medication intended for relief of conditions associated with their disease, such as depression and psychological issues, pruritus, and gastroparesis; however, such medications may increase the risk of RLS. Given the high prevalence of RLS in ESRD patients, these medications should only be used when their benefits clearly outweigh the risk of development of the troubling and distressing symptoms of RLS.