腎不全とrestless legs syndrome

抄録

The prevalence of restless legs syndrome (RLS) among dialysis patients in Japan decreased from 22.9%–23.4% in 2004–2006 to 9.4% in 2015. Similarly, the proportion of dialysis patients with the International Restless Legs Scale (IRLS) of 15 or higher, requiring drug treatment, has decreased from 10.5% to 2.5%. In dialysis patients, when administering drugs, it is necessary to adjust the dosage comprehensively, considering drug accumulation in the body, and the drug removal effects of dialysis compared to non–dialysis patients.

In our study, blood concentration measurements of Pramipexole in 12 cases revealed that dialysis removed 6.4%–20.9% of the drug, with an average removal rate of 11.8%. From the blood concentration levels during maintenance dosing in the Pramipexole drug package insert and the scatter plot (scatter plot of patients using 1 to 36 tablets for maintenance), it was found that the blood trough level when using 1 to 3 tablets of 0.125 mg daily was 8 to 12 times the dosage.

Rotigotine is effective at standard dosages even in dialysis patients. Pramipexole, even at a dose of one 0.125 mg tablet, may be excessive. Ropinirole is primarily excreted through the kidneys, but dose adjustment for dialysis is not necessary. Dopamine agonists are more likely to cause augmentation with long–term use and higher doses. However, augmentation is less likely with Rotigotine compared to Levodopa, Pramipexole, and Ropinirole.

α2δ ligands are expected to become the first–line treatment for non–dialysis patients due to their lower risk of augmentation. However, in dialysis patients, all drugs need to be used in reduced doses.

It is recommended to follow the anemia treatment guidelines for dialysis patients when using iron supplements.

Additionally, there are treatment methods specific to dialysis patients beyond pharmacological approaches.