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. 2018 Dec 24;12(4):559-563.
doi: 10.1093/ckj/sfy129. eCollection 2019 Aug.

Screening questions for the diagnosis of restless legs syndrome in hemodialysis

David Collister  1   2   3   4 , Jennifer C Rodrigues  1   2   3   4 , Andrea Mazzetti  2 , Kelsi Salisbury  2 , Laura Morosin  2 , Christian Rabbat  1   2 , K Scott Brimble  1   2 , Michael Walsh  1   2   3   4
Affiliations

Screening questions for the diagnosis of restless legs syndrome in hemodialysis

David Collister et al. Clin Kidney J. .

Abstract

Background: Restless legs syndrome (RLS) is common in end-stage renal disease and is associated with reduced health-related quality of life. Simple and accurate screening instruments are needed since RLS is underdiagnosed and treatable. We examined the operating characteristics of screening questions and a disease-specific measurement tool for the diagnosis of RLS in hemodialysis.

Methods: We conducted a cohort study of prevalent adult hemodialysis patients in Hamilton, Canada. The diagnosis of RLS was made using the 2012 Revised International Restless Legs Syndrome Study Group (IRLSSG) criteria. All participants received three screening instruments: (i) a single screening question for RLS derived from a nondialysis population; (ii) a single question from the Edmonton Symptom Assessment System (ESAS); and (iii) the IRLSSG Rating Scale (IRLS). All instruments were compared with the reference standard using logistic regression from which receiver operating characteristics curves were generated. Cutoffs associated with maximum performance were identified.

Results: We recruited 50 participants with a mean (SD) age of 64 (12.4) years, of whom 52% were male and 92% were on three times weekly hemodialysis. Using the reference standard, 14 (28%) had a diagnosis of RLS. The single screening question for RLS had an area under the receiver operating curve (AUROC) of 0.72 with a sensitivity of 85.7% and specificity of 58.3%. An ESAS cutoff of ≥1 had the highest AUROC at 0.65 with a sensitivity of 79% and specificity of 56%. An IRLS cutoff of ≥20 had the highest AUROC at 0.75 with a sensitivity of 71% and specificity of 81%.

Conclusion: IRLS had better specificity than the single question or ESAS for the diagnosis of RLS.

Keywords: patient-reported outcome measures; restless legs syndrome; screening.

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Figures

FIGURE 1
FIGURE 1
Receiver operating curve of the single question for the diagnosis of RLS from the general population. Sensitivity of 85.7%, specificity of 58.3%, AUROC of 0.72.
FIGURE 2
FIGURE 2
Receiver operating curve of ESAS-RLS for the diagnosis of RLS. ESAS-RLS cutoff of ≥1, sensitivity of 79%, specificity of 56%, AUROC of 0.65.
FIGURE 3
FIGURE 3
Receiver operating curve of IRLS for the diagnosis of RLS. IRLS cutoff of ≥20, sensitivity of 71%, specificity of 81%, AUROC of 0.75.
FIGURE 4
FIGURE 4
Scatterplot of ESAS-RLS and IRLS. r = 0.70, P = 0.0000. IRLS cutoff of ≥20 is labeled on the y-axis and ESAS-RLS cutoff of ≥1 is labeled on the x-axis.
See this image and copyright information in PMC

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