SP439EXERCISE TRAINING AND DOPAMINE AGONISTS IN HEMODIALYSIS PATIENTS WITH RESTLESS LEGS SYNDROME. A RANDOMIZED DOUBLE-BLIND PLACEBO CONTROLLED STUDY

Abstract

Introduction and Aims: Restless Legs Syndrome orWillis‐Ekbom Disease (RLS/ WED) is very common in the hemodialysis (HD) population known also as uremic RLS. Still, only a small number of clinical trials have investigated the long term treatment options in uremic RLS. Dopamine agonists (DA) are usually effective in improving uremic RLS symptoms; however, an increased dosage may be necessary as there is evidence indicating a decreased response after certain time. On the other hand, increased dosage and long‐term treatment with DA were found to be associated with augmentation and adverse effects phenomena. Recent data indicate that long‐term aerobic exercise could ameliorate the uremic RLS symptoms however, it is still unknown whether the combination of a low dose of DA and intradialytic exercise training could ameliorate the uremic RLS symptoms in a synergistic fashion. The aim of the current study is to investigate the effects of a six month combinational therapy of a low dose of DA and exercise training in RLS symptoms' severity in patients with uremic RLS. Methods: Fourteen stable HD patients with RLS were randomly assigned into the exercise training plus dopamine agonists group (ropinirole 0.25mg/d, N= 7, 55.5±8.8 years), and the exercise training plus placebo group (N= 7, 54.6±16.3 years). Intradialytic exercise training included 45 min cycling at the 60% of the maximum work load assessed and readjusted every month. The severity of RLS was assessed using the IRLS severity scale, physical performance by a battery of tests, muscle parameters by computed tomography, body composition by DEXA, and depression levels, sleep quality, daily sleepiness and quality of life (QoL) assessed through validated questionnaires. Results: Both the combinations were found to significantly improve uremic RLS symptoms, with no significant adverse effects. Exercise training in combination with dopamine agonists was able to induce significant and impressive changes in skeletal muscle quality, while improved the patient's quality of life. Functional capacity was improved by both approaches. Conclusions: Exercise alone or in combinations with low dosage dopamine agonist are effective approaches in reducing RLS symptoms and improving physical performance in patients with uremic RLS. However, only the combination of dopamine agonists and exercise training is effective in terms of inducing favorable changes in the patients' skeletal muscle and quality of life.