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Volume 15 No. 11
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Accepted Papers

Scientific Investigations

Restless Legs Syndrome in Chronic Kidney Disease: Is Iron or Inflammatory Status To Blame?

Sandeep K. Riar, MD1; Larry A. Greenbaum, MD, PhD2; Donald L. Bliwise, PhD3; Roberta M. Leu, MD4
1Pediatrics, Nephrology Division, University of Kansas Medical Center, Kansas City, Kansas; 2Pediatrics, Nephrology Division, Emory University and Children’s Healthcare of Atlanta, Atlanta, Georgia; 3Neurology, Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia; 4Division of Pulmonology, Allergy, Cystic Fibrosis and Sleep Medicine, Emory University and Children’s Healthcare of Atlanta, Atlanta, Georgia

Study Objectives:

Restless legs syndrome (RLS) is increased in pediatric chronic kidney disease (CKD). In adults without CKD, central nervous system iron deficiency is involved in RLS pathogenesis and a low serum ferritin levels is consequently an indication for initiation of iron therapy. However, children with CKD are at risk for iron deficiency and inflammation, which raises serum ferritin. We examined the role of iron deficiency and inflammation in RLS in pediatric CKD.


This cross-sectional study examined RLS prevalence in three groups of pediatric patients with CKD: nontransplant, nondialysis CKD (estimated GFR < 60 mL/min/1.73 m2) (n = 27); renal transplant recipients (n = 65); and dialysis (n = 32). RLS was diagnosed using a validated questionnaire. Serum ferritin < 100 ng/mL or transferrin saturation < 20% defined iron deficiency. Serum high sensitivity C-reactive protein ≥ 1 mg/L defined inflammation.


Among 124 patients, RLS prevalence was 15.3%; this did not differ across groups. There was no significant difference in RLS prevalence between those with and without iron deficiency, defined by either reduced ferritin or transferrin. Median ferritin levels in patients with RLS tended to be higher than in those without RLS (51.2 versus 40.1 ng/mL; P = .08). Inflammation (elevated CRP) also did not differ significantly by RLS status (57.9% [with RLS] versus 41.2% [without RLS], P = .18).


Neither ferritin nor inflammation differentiated pediatric patients with CKD with and without RLS. This study suggests that the factors mediating the pathogenesis and, potentially, treatment, of RLS in pediatric CKD may be different from non-CKD populations.


Riar SK, Greenbaum LA, Bliwise DL, Leu RM. Restless legs syndrome in chronic kidney disease: is iron or inflammatory status to blame? J Clin Sleep Med. 2019;15(11):1629–1634.

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