Abstract
Rationales: Restless leg syndrome (RLS) is a common complication in patients with end-stage renal disease (ESRD). However, there is a lack of biomarkers linking uremic RLS to dopaminergic neurons. Previous studies demonstrated that Tc-99m TRODAT-1 SPECT was a biomarker for RLS but the correlation between the physiologic parameter was lacking. Methods: Overall, 32 patients were enrolled in the study and divided into the following 3 groups: (1) control (n = 13), (2) ESRD without RLS (n = 8) and (3) ESRD with RLS (n = 11). All patients had a clinical diagnosis of RLS and received Tc-99m TRODAT-1 SPECT. A subgroup analysis was performed to compare differences between the control and ESRD with RLS groups. Tc-99m TRODAT-1 SPECT was performed and activities in the striatum and occipital areas were measured using manually delineated regions of interest (ROIs) by an experienced nuclear medicine radiologist who was blinded to clinical data. Results: The total ratio of Tc-99m TRODAT SPECT was lower in the ESRD with RLS group (p = 0.046). The uptake ratio of TRODAT negatively correlated with serum parathyroid hormone (r = −0.577, p = 0.015) and ferritin (r = −0.464, p = 0.039) concentrations. However, the uptake positively correlated with the hemoglobin concentration (r = 0.531, p = 0.011). The sensitivity and specificity of the total TRODAT ratio for predicting RLS in the overall population were 95.0% and 67.7%, respectively, at a cutoff value of 0.980 (area under the curve of receiver operating characteristic curve was 0.767, p = 0.024). Conclusion: In patients with ESRD and RLS, Tc-99m TRODAT might be a potential biomarker. Dysregulated hemoglobin, serum parathyroid hormone and serum ferritin concentrations might influence the uptake of the TRODAT ratio.
Highlights
Chronic kidney disease (CKD), defined as chronic renal function impairment because of the loss of glomerular filtration for more than 3 months, is a global health issue owing to its multiple complications and comorbidities [1]
We observed that the total TRODAT ratio was lower in the end-stage renal disease (ESRD) with Restless leg syndrome (RLS) group than in the ESRD without RLS and control groups
Upon comparison of the ESRD with RLS and control groups, it was observed that the lower TRODAT ratio correlated with lower serum hemoglobin, higher serum blood urea nitrogen (BUN), higher intact parathyroid hormone, higher ferritin and higher urine nickel concentrations
Summary
Chronic kidney disease (CKD), defined as chronic renal function impairment because of the loss of glomerular filtration for more than 3 months, is a global health issue owing to its multiple complications and comorbidities [1]. With the progression of glomerular filtration loss, the dysregulated fluid balance system, hormonal activation and specific uremic toxin retention induce systemic diseases, such as cardiovascular disease, renal osteodystrophy, dysregulated immunity and neurologic disorders [2]. Chronic neurologic complications, such as peripheral neuropathy, cognitive dysfunction or memory deficit, Parkinsonism and restless leg syndrome (RLS), are common in patients with CKD. Neurologic complications in patients with CKD are associated with limited activities of daily life and depressive mood, which are linked to devastating comorbidities, such as infection or increased mortality [3].
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